NPIMap

Individual provider Active NPI

Pablo Manuel Dejesus, PHYSICIAN ASSISTANT

  • Medical Physician Assistant
  • Palm Coast, FL
National Provider Identifier
1013176031
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9114008 Issued in FL
Practice address
Palm Coast Family Practice
9 Pine Cone Drive, Suite 102
Palm Coast, FL 32137
Phone
(386) 445-6191
Fax
(386) 445-3916
NPI assigned
Jun 5, 2008
Last updated
Dec 19, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9114008 FL Primary

Addresses

Primary practice location

Palm Coast Family Practice
9 Pine Cone Drive, Suite 102
Palm Coast, FL 32137

Mailing address

9 Pine Cone Dr Ste 102
Palm Coast, FL 32137-8683
Phone (386) 445-6191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231101003596 FL Practitioner - Physician Assistant 3173873585 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Palm Harbor Family Practice and Walk-in Clinic, P.aGroup PAC ID 9133108541, 7 clinicians

Practice addresses (Care Compare)

9 Pine Cone Dr
Suite 102
Palm Coast, FL 32137-8683
Phone (386) 445-6191

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9114008FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
F R Fruehan Family Practice Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1013176031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 PINE CONE DR STE 102",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378683",
            "telephone_number": "386-445-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PALM COAST FAMILY PRACTICE",
            "address_2": "9 PINE CONE DRIVE, SUITE 102",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "32137",
            "telephone_number": "386-445-6191",
            "fax_number": "386-445-3916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJESUS",
        "first_name": "PABLO",
        "middle_name": "MANUEL",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-05",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9114008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

Verify at the official NPI Registry.