NPIMap

Individual provider Active NPI

Daniel Ray Prentice, PA

  • Physician Assistant
  • Panama City, FL
National Provider Identifier
1013298363
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9106119 Issued in FL
Practice address
201 Forest Park Cir
Panama City, FL 32405-4916
Phone
(850) 248-7777
Fax
(850) 248-7779
NPI assigned
Aug 31, 2011
Last updated
May 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9106119 FL Primary

Addresses

Primary practice location

201 Forest Park Cir
Panama City, FL 32405-4916

Mailing address

7301 West Blvd Ste A1
Boardman, OH 44512-5268
Phone (330) 758-2775

Other practice location 1

11038 Hutchison Blvd
Panama City, FL 32407-3714
Phone (850) 588-5778

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
I20040209000690 FL Practitioner - Physician Assistant 6800780271 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9106119FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fawzi Soliman MD PA CurrentSince Aug 16, 2013 Accepting new patients
Richard W Springstead MD PA Past Accepting new patients
Chen-Sien Hu M D P a Past Accepting new patients
V.P. Nagarajan, M.D. Past Accepting new patients
Rodolfo L Dy MD PA Past Accepting new patients
Acsh Urgent Care of Florida, LLC Past Accepting new patients
Acsh Primary Care of Florida, LLC Past Accepting new patients
Trinity Surgical Associates P a Past Accepting new patients
Nature Coast Surgical Associates, PA Past Accepting new patients
Terrell B. Bounds MD.,PA Past Accepting new patients
Daniel R Prentice PA-C PA Past Accepting new patients
John Parrinello, PA PastSince Sep 1, 2006 Accepting new patients
Community Hospital Family Practice LLC PastSince May 1, 2016 Accepting new patients
Florida Surgery Consultants, LLC PastSince Jun 1, 2017 Accepting new patients

Locations

12132 Cortez Blvd
Brooksville, FL 34613
Phone (352) 592-4711

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ECFBCA

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1013298363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 WEST BLVD STE A1",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125268",
            "telephone_number": "330-758-2775",
            "fax_number": "330-758-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 FOREST PARK CIR",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054916",
            "telephone_number": "850-248-7777",
            "fax_number": "850-248-7779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11038 Hutchison Blvd",
            "address_purpose": "LOCATION",
            "city": "Panama City",
            "state": "FL",
            "postal_code": "324073714",
            "country_code": "US",
            "telephone_number": "850-588-5778",
            "fax_number": "850-588-5718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRENTICE",
        "first_name": "DANIEL",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-31",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

Verify at the official NPI Registry.