NPIMap

Individual provider Active NPI

Michael Berry, PA

  • Medical Physician Assistant
  • Crescent City, FL
National Provider Identifier
1083601900
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA2470 Issued in FL
Practice address
811 N Summit St
Crescent City, FL 32112-2191
Phone
(386) 698-2101
NPI assigned
Oct 5, 2005
Last updated
Feb 23, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA2470 FL Primary

Addresses

Primary practice location

811 N Summit St
Crescent City, FL 32112-2191

Mailing address

PO Box 2400
Melbourne, FL 32902-2400
Phone (321) 837-3820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110225000393 FL Practitioner - Physician Assistant 2264613173 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Island Doctors Intrastate LLCGroup PAC ID 5395161186, 74 clinicians

Practice addresses (Care Compare)

100 Arricola Ave
Saint Augustine, FL 32080-4515
Phone (904) 825-4368

2460 Old Moultrie Rd
St Augustine, FL 32086-4198

811 N Summit St
Island Doctors Crescent City
Crescent City, FL 32112-2191
Phone (386) 698-2101

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA2470FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Guidewell Emergency Medicine Doctors, LLC PastSince Apr 6, 2025 Accepting new patients

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1083601900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2400",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329022400",
            "telephone_number": "321-837-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 N SUMMIT ST",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321122191",
            "telephone_number": "386-698-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA2470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crescent City, FL

Sources for this page

Verify at the official NPI Registry.