SHANDS JACKSONVILLE
Complete NPI Record 1821186313
General Acute Care Hospital in Jacksonville, FL
Active since October 10, 2006CLIA Certified · 3 labs
3/5
Hospital Overall Rating
Complete NPI Dataset
This page contains the complete raw NPPES record for Shands Jacksonville (NPI 1821186313), a general acute care hospital organization in Jacksonville, FL. All 38 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1821186313 Field 1/38
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/38
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/38
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: SHANDS JACKSONVILLE MEDICAL CENTER INC Field 4/38
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: SHANDS JACKSONVILLE Field 5/38
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 3 Field 6/38
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 655 W 8TH ST Field 7/38
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: JACKSONVILLE Field 8/38
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: FL Field 9/38
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 322096511 Field 10/38
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/38
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 9042448675 Field 12/38
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 9042444027 Field 13/38
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 655 W 8TH ST Field 14/38
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: JACKSONVILLE Field 15/38
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: FL Field 16/38
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 322096511 Field 17/38
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/38
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 9042448675 Field 19/38
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 9042444027 Field 20/38
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: COCCHI Field 23/38
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: DEAN Field 24/38
- The first name of the authorized official.
- Authorized Official Title or Position: CHIEF FINANCIAL OFFICER Field 25/38
- The title or position of the authorized official.
- Authorized Official Telephone Number: 9042445013 Field 26/38
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 261QU0200X Field 27/38
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 28/38
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 282N00000X Field 29/38
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 2: 4063 Field 30/38
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 2: FL Field 31/38
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 2: Y Field 32/38
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: IP010067600 Field 33/38
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 34/38
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: FL Field 35/38
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Organization Subpart: N Field 36/38
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Authorized Official Name Prefix Text: MR. Field 37/38
- The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.
Secondary Practice Locations 13
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
15255 MAX LEGGETT PKWY, STE 4100
Location 1/13JACKSONVILLE, FL 32218-7273 · Phone (904) 244-3477
15255 MAX LEGGETT PKWY, 1ST AND 2ND FLOORS MEDICAL OFFICE BUILDING
Location 2/13JACKSONVILLE, FL 32218-7273 · Phone (904) 244-1209
15255 MAX LEGGETT PKWY, STE 5600 UF HEALTH SLEEP CENTER NORTH
Location 3/13JACKSONVILLE, FL 32218-7273 · Phone (904) 244-1209
3465 VILLAGE CENTER DR
Location 4/13JACKSONVILLE, FL 32206-8617 · Phone (904) 244-1209
2141 LOCH RANE BLVD, STE 117
Location 5/13ORANGE PARK, FL 32073-4239 · Phone (904) 244-3477
7751 BAYMEADOWS RD E, STE 205
Location 6/13JACKSONVILLE, FL 32256-5836 · Phone (904) 244-1209
4549 EMERSON ST, BUILDING 2 STE 300
Location 7/13JACKSONVILLE, FL 32207-4961 · Phone (904) 244-3477
425 NORTH LEE ST, STE 204
Location 8/13JACKSONVILLE, FL 32204-1127 · Phone (904) 277-3477
1699 S 14TH ST, STE 1
Location 9/13FERNANDINA BEACH, FL 32034-1995 · Phone (904) 244-3477
1122 W 11TH ST
Location 10/13JACKSONVILLE, FL 32209-6511 · Phone (904) 244-1209
1155 EAST 21ST ST
Location 11/13JACKSONVILLE, FL 32206-2401 · Phone (904) 244-1209
4549 EMERSON ST, BUILDING 2 STE 100
Location 12/13JACKSONVILLE, FL 32207-4961 · Phone (904) 244-1209
15255 MAX LEGGETT PKWY, STE 6000 UF HEALTH ONCOLOGY NORTH
Location 13/13JACKSONVILLE, FL 32218-7273 · Phone (904) 244-3477
Other Provider Identifiers 1
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
IP010067600 Medicaid
Identifier 1/1State: FL
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
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