NPIMap

Individual provider Active NPI

Jonathan Carroll, PA-C

  • Physician Assistant
  • Gainesville, FL
National Provider Identifier
1093115818
Registry record updated May 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9108305 Issued in FL
Practice address
1600 SW Archer Rd
Division of Vascular Surgery - Box 100128
Gainesville, FL 32610-0128
Phone
(352) 273-5484
NPI assigned
Aug 28, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9108305 FL
Physician Assistant 363A00000X PA9108305 FL Primary

Addresses

Primary practice location

1600 SW Archer Rd
Division of Vascular Surgery - Box 100128
Gainesville, FL 32610-0128

Mailing address

1600 SW Archer Rd
Division of Vascular Surgery - Box 100128
Gainesville, FL 32610-0128
Phone (352) 273-5484

Other identifiers 1

IdentifierTypeStateIssuer
014722600MedicaidFL

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
I20150529000460 FL Practitioner - Physician Assistant 0547580797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1505 SW Archer Rd
Gainesville, FL 32608-1134

2001 SW 13TH St
Gainesville, FL 32608-1532
Phone (352) 265-8990

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
47.54 of 100Reported as apm
Quality
38.49
Promoting interoperability
0
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9108305FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Mar 22, 2018 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Mar 22, 2018 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1505 SW Archer Rd
Gainesville, FL 32608
Phone (352) 265-5470

1600 SW Archer Rd
#100128
Gainesville, FL 32610
Phone (352) 273-5484

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

1600 SW Archer Rd
#100371
Gainesville, FL 32610
Phone (352) 265-8335

1500 SE 17th St
Ste 600
Ocala, FL 34471
Phone (352) 273-7770

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: jcarroll208928@direct.shands.ufl.edu

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.

Hospital & facility affiliations 8

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": "1409184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494288000000",
    "number": "1093115818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "address_2": "DIVISION OF VASCULAR SURGERY - BOX 100128",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100128",
            "telephone_number": "352-273-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "address_2": "DIVISION OF VASCULAR SURGERY - BOX 100128",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100128",
            "telephone_number": "352-273-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JONATHAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-28",
        "last_updated": "2017-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9108305",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014722600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.