Individual provider Active NPI

Samantha Lynn Mizell, PA-C

  • Physician Assistant
  • Tampa, FL
National Provider Identifier
1073209607
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1 Tampa General Cir
Tampa, FL 33606-3571
Phone
(502) 797-2649
NPI assigned
Apr 17, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 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 Primary

Addresses

Primary practice location

1 Tampa General Cir
Tampa, FL 33606-3571

Mailing address

1805 Ashford Dr
Goshen, KY 40026-8418
Phone (502) 797-2649

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
I20230925000224 FL Practitioner - Physician Assistant 3971957010 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of South Florida College of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4202 E Fowler Ave
Tampa, FL 33620-6750

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Service Association Inc CurrentSince Sep 8, 2023 Accepting new patients
University Medical Service Association Inc CurrentSince Sep 8, 2023 Accepting new patients
Tampa General Hospital Current Accepting new patients
University Medical Service Association Inc Physician Assistant Past Accepting new patients

Locations

12901 Bruce B Downs Blvd
#62
Tampa, FL 33612

4202 E Fowler Ave
Stop SHS100
Tampa, FL 33620
Phone (813) 974-2331

2 Tampa General Cir
Tampa, FL 33606
Phone (813) 259-8700

1 Tampa General Cir
University of Tampa, FL 33606
Phone (813) 251-5822

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: smizell270694@direct.tgh.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

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": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1073209607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 ASHFORD DR",
            "city": "GOSHEN",
            "state": "KY",
            "postal_code": "400268418",
            "telephone_number": "502-797-2649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 TAMPA GENERAL CIR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336063571",
            "telephone_number": "502-797-2649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZELL",
        "first_name": "SAMANTHA",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.