Individual provider Active NPI

Anthony A. Azzarello, PA

  • Physician Assistant
  • Daytona Beach, FL
National Provider Identifier
1073568747
Registry record updated Oct 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9103151 Issued in FL
Practice address
303 No. Clyde Morris Blvd.
Halifax Medical Center - Chest Pain Center
Daytona Beach, FL 32114-2709
Phone
(386) 425-1800
Fax
(386) 425-1804
NPI assigned
May 23, 2006
Last updated
Oct 26, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2011

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 PA9103151 FL Primary

Addresses

Primary practice location

303 No. Clyde Morris Blvd.
Halifax Medical Center - Chest Pain Center
Daytona Beach, FL 32114-2709

Mailing address

PO Box Box 864074
Halifax Healthcare Systems, Inc.
Orlando, FL 32886-4074
Phone (386) 226-4590

Other identifiers 1

IdentifierTypeStateIssuer
292228200MedicaidFL

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
I20050914000500 FL Practitioner - Physician Assistant 5799718359 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Halifax Healthcare Systems IncGroup PAC ID 1254238090, 345 clinicians

Practice addresses (Care Compare)

303 N Clyde Morris Blvd
Daytona BCH, FL 32114-2709

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Halifax Healthcare Systems Inc CurrentSince May 1, 2005 Accepting new patients

Locations

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

303 N Clyde Morris Blvd
Fl 10
Daytona Beach, FL 32114
Phone (386) 425-2360

740 Dunlawton Ave
Ste 100
Port Orange, FL 32127
Phone (386) 767-2402

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319587200000",
    "number": "1073568747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX BOX 864074",
            "address_2": "HALIFAX HEALTHCARE SYSTEMS, INC.",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328864074",
            "telephone_number": "386-226-4590",
            "fax_number": "386-226-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 NO. CLYDE MORRIS BLVD.",
            "address_2": "HALIFAX MEDICAL CENTER - CHEST PAIN CENTER",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142709",
            "telephone_number": "386-425-1800",
            "fax_number": "386-425-1804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZZARELLO",
        "first_name": "ANTHONY",
        "middle_name": "A.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2011-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292228200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.