OrganizationActive
Mainland Physicians Group LLC
NPI 1003419763 · Geriatric Medicine (Family Medicine) Physician · St Augustine, FL
Provider details
- NPI number
- 1003419763
- Entity type
- Organization
- Primary specialty
- Geriatric Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- John Paul Shaddock, Director of Network Managment(850) 341-6322
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(63/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
100 Arricola Ave
St Augustine, FL 32080-4515
Phone: (904) 825-4368
Fax: (904) 825-9107
Street-level locationGet directions
Mailing address
100 Arricola Ave
St Augustine, FL 32080-4515
Registry dates
- Enumerated
- 2020-11-17
- Last updated
- 2020-11-17
- Certified
- 2020-11-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.