Individual provider Active NPI

Tito Velasquez

  • Physician Assistant
  • Fort Lauderdale, FL
National Provider Identifier
1013551266
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9112704 Issued in FL
Practice address
1160 N Federal Hwy Apt 1023
Fort Lauderdale, FL 33304-1436
Phone
(312) 833-1183
NPI assigned
Oct 31, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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 9112704 FL Primary

Addresses

Primary practice location

1160 N Federal Hwy Apt 1023
Fort Lauderdale, FL 33304-1436

Mailing address

1160 N Federal Hwy Apt 1023
Fort Lauderdale, FL 33304-1436
Phone (312) 833-1183

Other identifiers 1

IdentifierTypeStateIssuer
9112704OtherFLNCCPA FLORIDA STATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20200131001414 FL Practitioner - Physician Assistant 1456787969 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lee Health System IncGroup PAC ID 9335672146, 1,381 clinicians

Practice addresses (Care Compare)

1138 Country Club Blvd
Cape Coral, FL 33990-3027
Phone (239) 424-1900

3501 Health Ctr Blvd
Estero, FL 34135-8127

9800 S Healthpark Dr
Fort Myers, FL 33908-3630

Hospital & facility affiliations

  • Lee Memorial Hospital Hospital, Fort Myers, FL, CCN 100012
  • Cape Coral Hospital Hospital, Cape Coral, FL, CCN 100244
  • Gulf Coast Medical Center Lee Health Hospital, Fort Myers, FL, CCN 100220

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9112704FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Health System Inc CurrentSince Nov 1, 2024 Accepting new patients
Lee Memorial Health System CurrentSince Dec 1, 2022 Accepting new patients
Lee Health System Inc CurrentSince Nov 1, 2024 Accepting new patients
Lee Memorial Health System CurrentSince Dec 1, 2022 Accepting new patients

Locations

1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900

3501 Health Center Blvd
Ste 1600
Estero, FL 34135
Phone (239) 343-1219

1569 Matthew Dr
Fort Myers, FL 33907
Phone (941) 939-1700

9800 S Healthpark Dr
Ste 110
Fort Myers, FL 33908
Phone (239) 344-2307

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

16410 Healthpark Commons Dr
Fort Myers, FL 33908

930 S Main St
Ste C
Labelle, FL 33935
Phone (239) 674-5520

Networks

  • Freedom Health HMO Network

Organizations & group practices 5

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 3

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": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1013551266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 N FEDERAL HWY APT 1023",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333041436",
            "telephone_number": "312-833-1183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 N FEDERAL HWY APT 1023",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333041436",
            "telephone_number": "312-833-1183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELASQUEZ",
        "first_name": "TITO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-31",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9112704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA FLORIDA STATE LICENSE",
            "identifier": "9112704",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.