Podiatry Associates of Northeast Florida Inc – Podiatrist, NPI 1578664074
Podiatrist
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Podiatry Associates of Northeast Florida Inc
12, Kingsley Avenue, Orange Park, Clay County, Florida, 32073, United States
ORANGE PARK, FL 320735129
Phone: (904) 224-2001
Fax: (904) 224-2002
Type: Mailing
1361, 13th Avenue South, Oceanside Park, Jacksonville Beach, Duval County, Florida, 32250, United States
STE 120
JACKSONVILLE BEACH, FL 322503233
Phone: (904) 224-2001
Fax: (904) 224-2002
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20050324000347 | O | Clinic/Group Practice | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32073)
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