Individual provider Active NPI

Mindy Ley Romanov, PA

  • Physician Assistant
  • St Petersburg, FL
National Provider Identifier
1043689763
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9108984 Issued in FL
Practice address
6450 38TH Ave N Ste 420
St Petersburg, FL 33710-1653
Phone
(727) 344-6851
NPI assigned
Sep 23, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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 PA9108984 FL Primary

Addresses

Primary practice location

6450 38TH Ave N Ste 420
St Petersburg, FL 33710-1653

Mailing address

151 Southhall LN Ste 300
Maitland, FL 32751-7172
Phone (407) 917-7293

Other names 1

  • Mindy Ley Former name

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
I20151228002370 FL Practitioner - Physician Assistant 0143521666 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1410 W Broadway St
Suite 205
Oviedo, FL 32765-6472
Phone (407) 359-2100

1503 Buenos Aires Blvd
Suite 100
The Villages, FL 32159-6825
Phone (352) 753-2812

202 Lake Miriam Dr
Suite S1
Lakeland, FL 33813-2188
Phone (863) 647-2333

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9108984FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Florida Dermatology Associates P.a. CurrentSince Oct 1, 2015 Accepting new patients
Leavitt Medical Associates of Florida Inc CurrentSince Mar 1, 2022 Accepting new patients
Leavitt Medical Associates of Florida Inc CurrentSince Mar 1, 2022 Accepting new patients
Leavitt Medical Associates of Florida Inc Past Accepting new patients
Leavitt Medical Associates of Florida Inc Past Accepting new patients

Locations

4106 W Lake Mary Blvd
Ste 324
Lake Mary, FL 32746
Phone (407) 322-5522

202 Lake Miriam Dr
Ste S1
Lakeland, FL 33813
Phone (863) 647-2333

151 Southhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 917-7293

7652 Ashley Park Ct
Ste 305
Orlando, FL 32835
Phone (407) 839-0127

100 W Gore St
Ste 602
Orlando, FL 32806
Phone (407) 839-3999

1410 W Broadway St
Ste 205
Oviedo, FL 32765
Phone (407) 359-2100

6450 38th Ave N
Ste 420
St Petersburg, FL 33710
Phone (727) 344-6851

1503 Buenos Aires Blvd
Ste 100
The Villages, FL 32159
Phone (352) 753-2812

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare 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.

NPI Registry JSON

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1043689763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172",
            "telephone_number": "407-917-7293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6450 38TH AVE N STE 420",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337101653",
            "telephone_number": "727-344-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMANOV",
        "first_name": "MINDY",
        "middle_name": "LEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-23",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MINDY",
            "last_name": "LEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.