Active NPI
Kelsey Waltz, PA-C
- Physician Assistant
- Lithia, FL
National Provider Identifier
1013324680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 13837 Circa Crossing Dr
Lithia, FL 33547-4382 - Phone
- (813) 684-2663
- Fax
- (813) 658-6222
- NPI assigned
- Jul 16, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
13837 Circa Crossing Dr
Lithia, FL 33547-4382
Mailing address
13837 Circa Crossing Dr
Lithia, FL 33547-4382
Phone (813) 684-2663
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CGCJBD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698278400000",
"number": "1013324680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13837 CIRCA CROSSING DR",
"city": "LITHIA",
"state": "FL",
"postal_code": "335474382",
"telephone_number": "813-684-2663",
"fax_number": "813-658-6222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13837 CIRCA CROSSING DR",
"city": "LITHIA",
"state": "FL",
"postal_code": "335474382",
"telephone_number": "813-684-2663",
"fax_number": "813-658-6222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTZ",
"first_name": "KELSEY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-16",
"last_updated": "2023-10-26",
"certification_date": "2023-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lithia, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.