Individual provider Active NPI

Thomas Alexander Lekavich, PA

  • Medical Physician Assistant
  • Tampa, FL
National Provider Identifier
1063465623
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9102189 Issued in FL
Practice address
13021 W Linebaugh Ave Ste 102
Tampa, FL 33626-4509
Phone
(813) 709-8567
Fax
(215) 642-8552
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9102189 FL
Medical Physician Assistant 363AM0700X PA9102189 FL Primary

Addresses

Primary practice location

13021 W Linebaugh Ave Ste 102
Tampa, FL 33626-4509

Mailing address

1601 W Reynolds St Ste 104
Plant City, FL 33563-4708
Phone (813) 709-8567

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
I20060717000186 FL Practitioner - Physician Assistant 6901819937

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9102189FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Vital Eagles Health Care Inc Physician Assistant CurrentSince Jul 6, 2023 Accepting new patients
Ballout International PLLC Physician Assistant Past Accepting new patients
Michael D Boehm MD PA PastSince Oct 1, 2023 Accepting new patients

Locations

1601 W Reynolds St
Ste 104
Plant City, FL 33563
Phone (813) 709-8567

13021 W Linebaugh Ave
Ste 102
Tampa, FL 33626
Phone (215) 205-2229

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.

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1063465623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 W REYNOLDS ST STE 104",
            "city": "PLANT CITY",
            "state": "FL",
            "postal_code": "335634708",
            "telephone_number": "813-709-8567",
            "fax_number": "215-642-8552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13021 W LINEBAUGH AVE STE 102",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336264509",
            "telephone_number": "813-709-8567",
            "fax_number": "215-642-8552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEKAVICH",
        "first_name": "THOMAS",
        "middle_name": "ALEXANDER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102189",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9102189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.