Individual provider Active NPI

Michael T O'Leary, PA-C

  • Physician Assistant
  • Pensacola, FL
National Provider Identifier
1083918189
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
220 Hovey Rd
Pensacola, FL 32508-1044
Phone
(850) 452-4554
NPI assigned
Jan 4, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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 0110003642 VA
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

220 Hovey Rd
Pensacola, FL 32508-1044

Mailing address

220 Hovey Rd
Pensacola, FL 32508-1044
Phone (850) 452-9612

Other practice location 1

620 John Paul Jones Cir
Portsmouth, VA 23708-2111
Phone (757) 953-8230

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20231220001896 RI Practitioner - Physician Assistant 8921266081 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virginia Oak Counseling LLCGroup PAC ID 4981945870, 14 clinicians

Practice addresses (Care Compare)

2984 E Main Rd
Portsmouth, RI 02871-4232
Phone (703) 493-0467

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Two Rivers Counseling LLC PastSince Jul 1, 2025 Accepting new patients
Tidewater Emergency Medical Care Physician Assistant PastSince Feb 2, 2020 Accepting new patients

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": "1294099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1083918189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 HOVEY RD",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325081044",
            "telephone_number": "850-452-9612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 HOVEY RD",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325081044",
            "telephone_number": "850-452-4554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 John Paul Jones Cir",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "VA",
            "postal_code": "237082111",
            "country_code": "US",
            "telephone_number": "757-953-8230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'LEARY",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-04",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110003642",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.