MAYO CLINIC JACKSONVILLE – Multi-Specialty Clinic/Center, NPI 1790772317
Multi-Specialty Clinic/Center
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MAYO CLINIC JACKSONVILLE
4500 SAN PABLO RD S
JACKSONVILLE, FL 322241865
Phone: (904) 953-7355
Fax: (904) 953-1768
Type: Mailing
San Pablo Road, Holiday Harbor, Jacksonville, Duval County, Florida, 32224, United States
JACKSONVILLE, FL 322241865
Phone: (904) 953-7355
Fax: (904) 953-1768
Type: Mailing
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.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-10-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-09-30 (983 days ago).
Enrollment records
3
Earliest due date
2023-09-30
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 |
|---|---|---|---|---|
| O20031118000388 | O | Clinic/Group Practice | FL | TBD |
| O20100930079068 | O | Physician - General Practice | FL | 2024-10-31 |
| O20180905001256 | O | Clinic/Group Practice | MN | 2023-09-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 32224)
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