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MILLENNIUM PHYSICIAN GROUP LLC
NPI 1720750417
Family Medicine in Jacksonville, FL

Active since September 30, 2021CLIA Certified · 3 labs
11513 N MAIN ST, JACKSONVILLE, FL 32218(904) 751-6200(904) 751-1600 Get Directions Write a Review

NPPES record last updated: January 19, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 19, 2023, Sep 30, 2021 (2 updates tracked since 2021).

About Millennium Physician Group Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MILLENNIUM PHYSICIAN GROUP LLC (NPI 1720750417) is a healthcare organization registered as a family medicine in Jacksonville, Florida and active in the NPI registry since September 2021. The organization holds 3 active CLIA laboratory certificates and lists Mary Haltigan, Director Of Revenue Cycle, as its authorized official.

NPPES Registry Identity

NPI1720750417
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMILLENNIUM PHYSICIAN GROUP LLC
Location Address11513 N MAIN STJacksonville, FL 32218-4002
Mailing Address2675 Winkler Ave Fl 2Fort Myers, FL 33901-9342 · (877) 856-3774 · Fax (239) 599-2612
Phone(904) 751-6200
Fax(904) 751-1600
Organization SubpartNo
Authorized OfficialMary HaltiganDirector Of Revenue Cycle · (877) 856-3774
Enumeration DateSeptember 30, 2021
Last NPPES UpdateJanuary 19, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 19, 2023
✔ NPI 1720750417 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
11513 N MAIN ST, Jacksonville, FL 32218
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 10D0688318

Millennium Physician Group LLC · Jacksonville, FL
Active · expires Aug 21, 2026
CLIA Number10D0688318
Laboratory TypePhysician Office
Certificate Effective DateAugust 22, 2024
Certificate Expiration DateAugust 21, 2026
Laboratory DirectorVictor C. Micolucci
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group LLC11513 N Main St, Jacksonville, FL 32218
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 10D2258915

Millennium Physician Group, LLC · Jacksonville, FL
Active · expires Apr 27, 2028
CLIA Number10D2258915
Laboratory TypePhysician Office
Certificate Effective DateApril 28, 2026
Certificate Expiration DateApril 27, 2028
Laboratory DirectorChristopher Scuderi
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group, LLC14043 North Main St #107, Jacksonville, FL 32218
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D0918712

Millennium Physician Group LLC · Jacksonville, FL
Active · expires Sep 11, 2026
CLIA Number10D0918712
Laboratory TypePhysician Office
Certificate Effective DateSeptember 12, 2024
Certificate Expiration DateSeptember 11, 2026
Laboratory DirectorCharles J. Haddad
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group LLC2377 Dunn Ave, Jacksonville, FL 32218
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TIFFANY B JONES
Nurse Practitioner (Family)
11513 N MAIN ST
JACKSONVILLE, FL 32218
Duval County (855) 674-7400
ELIZABETH BREZA ARNP-BC
Nurse Practitioner (Adult Health)
11513 N MAIN ST
JACKSONVILLE, FL 32218
Duval County (904) 751-6200
NICOLE ALEXANDRA BENJAMIN
Physician Assistant
11513 N MAIN ST
JACKSONVILLE, FL 32218
Duval County (904) 751-6200
STEPHANIE ESPOSITO APRN, FNP-C
Nurse Practitioner (Family)
11513 N MAIN ST
JACKSONVILLE, FL 32218
Duval County (904) 751-6200
TAYLOR GREGORY TRACE PA-C
Physician Assistant
11513 N MAIN ST
JACKSONVILLE, FL 32218
Duval County (904) 751-6200
BAPTIST CARDIOLOGY, INC.
Internal Medicine (Cardiovascular Disease)
11513 N MAIN ST
JACKSONVILLE, FL 32218
Duval County (904) 720-0799
OCEANWAY MEDICAL CENTER, INC.
Family Medicine
11513 N MAIN ST
JACKSONVILLE, FL 32218
Duval County (904) 751-6200
BURTON H. MENDEL PA
Physician Assistant
11513 N MAIN ST
JACKSONVILLE, FL 32218
Duval County (904) 751-6200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Millennium Physician Group LLC's NPI number?

The NPI number for Millennium Physician Group LLC is 1720750417. It was assigned to this organization in the NPPES registry on September 30, 2021.

Where is Millennium Physician Group LLC located?

Millennium Physician Group LLC is located at 11513 N Main St, Jacksonville, FL 32218. The listed phone number is (904) 751-6200.

What is Millennium Physician Group LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Millennium Physician Group LLC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Millennium Physician Group LLC accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Millennium Physician Group LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Millennium Physician Group LLC was last updated on January 19, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.