Individual provider Active NPI

Seydel Yanitza Dubon, PA-C

  • Physician Assistant
  • Gainesville, FL
National Provider Identifier
1013408871
Registry record updated Aug 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9111395 Issued in FL
Practice address
2000 SW Archer Rd
Gainesville, FL 32608
Phone
(352) 265-0129
NPI assigned
May 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X PA9111395 FL Primary

Addresses

Primary practice location

2000 SW Archer Rd
Gainesville, FL 32608

Mailing address

PO Box 100226
Gainesville, FL 32610-0226
Phone (352) 273-8661

Other identifiers 1

IdentifierTypeStateIssuer
100335700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240816002967 WA Practitioner - Physician Assistant 0446500144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peacehealth Networks on Demand LLCGroup PAC ID 1759731383, 197 clinicians

Practice addresses (Care Compare)

10541 NE 4TH St
Bellevue, WA 98004-5023
Phone (864) 664-3984

19220 Alderwood Mall Pkwy
Suite 145
Lynnwood, WA 98036-4819
Phone (864) 664-3984

2038 NW Market St
Seattle, WA 98107-4012
Phone (864) 664-3984

Hospital & facility affiliations

  • Swedish Medical Center Hospital, Seattle, WA, CCN 500027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9111395FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Zoomcare PC Past Accepting new patients
Zoomcare Urgent Care LLC PastSince Aug 6, 2023 Accepting new patients

Networks

  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e
  • WA PPO C-SNP

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/30646/brand/1/csg/1/fhir/r4
  • Direct secure messaging: seydel.dubon.1@30646.direct.athenahealth.com

Organizations & group practices 3

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

Hospital & facility affiliations 1

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": "1527465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534204800000",
    "number": "1013408871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100226",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100226",
            "telephone_number": "352-273-8661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "32608",
            "telephone_number": "352-265-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBON",
        "first_name": "SEYDEL",
        "middle_name": "YANITZA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-28",
        "last_updated": "2018-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100335700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.