Individual provider Active NPI

Deanna Jantsch, PA-C

  • Physician Assistant
  • Port Saint Lucie, FL
National Provider Identifier
1083324255
Registry record updated Nov 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1400 SE Goldtree Dr Ste 103
Port Saint Lucie, FL 34952-7582
Phone
(772) 335-8446
NPI assigned
Nov 29, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2022

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

1400 SE Goldtree Dr Ste 103
Port Saint Lucie, FL 34952-7582

Mailing address

4071 Church Creek PT
Largo, FL 33774-1000

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
I20230127000717 FL Practitioner - Physician Assistant 7618348764 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palm Beach General Surgery LLCGroup PAC ID 1456455021, 69 clinicians

Practice addresses (Care Compare)

1800 SE Tiffany Ave
St Lucie Medical Center
Port Saint Lucie, FL 34952-7521
Phone (772) 335-4000

1825 SE Tiffany Ave
Port Saint Lucie, FL 34952-7554
Phone (772) 335-4000

1881 SE Tiffany Ave
Suite 301
Port Saint Lucie, FL 34952-7567
Phone (772) 335-8446

Hospital & facility affiliations

  • St Lucie Medical Center Hospital, Port Saint Lucie, FL, CCN 100260

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Palm Beach General Surgery LLC PastSince Dec 6, 2022 Accepting new patients

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12719/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

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": "1669680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1083324255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4071 CHURCH CREEK PT",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337741000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 SE GOLDTREE DR STE 103",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527582",
            "telephone_number": "772-335-8446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANTSCH",
        "first_name": "DEANNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-29",
        "last_updated": "2022-11-29",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

Verify at the official NPI Registry.