Tina R Ellison, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9117754 Issued in FL

Practice address

61 Memorial Medical Pkwy Ste 1-800a
Palm Coast, FL 32164-5983

Phone

(386) 302-1365

NPI assigned

Dec 27, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Tina R Hasrouni Former name

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

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Hospital Healthcare Partners, IncGroup PAC ID 7012266836, 621 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• AdventHealth Palm Coast Hospital, Palm Coast, FL, CCN 100118
• Adventhealth Palm Coast Parkway Hospital, Palm Coast, FL, CCN 100363

Merit-based Incentive Payment System (MIPS)

Final score

84.59 of 100Reported as group

Quality

74.46

Promoting interoperability

99

Improvement activities

40

Cost

75

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: tellison3737105@adventhealth.direct-ci.com

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.

• Florida Hospital Healthcare Partners, Inc

  • Internal Medicine Physician
  • Daytona Beach, FL
  • NPI 1780100529
  Medicare reassignment Care Compare group
• Memorial Hospital Flagler Inc

  dba AdventHealth Palm Coast

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1679678486
  NPD
• Memorial Hospital Flagler Inc.

  dba AdventHealth Medical Group

  • Multi-Specialty Clinic/Center
  • Palm Coast, FL
  • NPI 1558530600
  NPD
• Adventhealth Primary Care Network Inc

  • Family Medicine Physician
  • Altamonte Springs, FL
  • NPI 1093493637
  NPD (past)
• Capital Regional Healthcare

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1518968551
  NPD (past)

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

• Adventhealth Palm Coast Parkway Inc

  dba Adventhealth Palm Coast Parkway

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1861102345
  Care Compare affiliation
• Memorial Hospital Flagler Inc

  dba AdventHealth Palm Coast

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1679678486
  Care Compare affiliation

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1033196571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 946383",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303946383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 MEMORIAL MEDICAL PKWY STE 1-800A",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321645983",
            "telephone_number": "386-302-1365"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2626 Care Dr Ste 105",
            "address_purpose": "LOCATION",
            "city": "Tallahassee",
            "state": "FL",
            "postal_code": "323084489",
            "country_code": "US",
            "telephone_number": "850-402-3104",
            "fax_number": "850-402-9979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "TINA",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-27",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50-001637",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9117754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000316099",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00079777",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "HASROUNI",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Lynn Elfrink
• Brianna Ellis
• Darbi Ellis, MS- CF SLP
• Kaitlyn Leigh Ellis, DC
• Kayla Ellison
• Elocin Enterprises, LLC (Elite Comfort Companion Services)
• Omar Elsekaily
• Emcare Physician Providers, Inc.
• Emergency Medicine Professionals PA
• Emergency Medicine Professionals PA

• Physician Assistant in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.