Jared A Destackelberg, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAT 9105672 Issued in FL

Practice address

1901 SE 18TH Ave
Ste 101
Ocala, FL 34471-8215

Phone

(352) 622-3360

Fax

(352) 671-3269

NPI assigned

Oct 21, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SMH Physician Services IncGroup PAC ID 1355240177, 781 clinicians

Neurosurgery and Spine SpecialistsGroup PAC ID 2668434788, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sarasota Memorial Hospital Hospital, Sarasota, FL, CCN 100087
• Sarasota Memorial Hospital - Venice Hospital, North Venice, FL, CCN 100359

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

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.

• SMH Physician Services Inc

  • Internal Medicine Physician
  • Sarasota, FL
  • NPI 1346295292

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Neurosurgery & Spine Specialists

  • Neurological Surgery Physician
  • Sarasota, FL
  • NPI 1033299441
  Medicare reassignment Care Compare group
• SMH Physician Services Inc

  • Gynecology Physician
  • Sarasota, FL
  • NPI 1275525826
  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sarasota County Public Hospital District

  • General Acute Care Hospital
  • North Venice, FL
  • NPI 1013534445
  Care Compare affiliation
• Sarasota County Public Hospital District

  • General Acute Care Hospital
  • Sarasota, FL
  • NPI 1245294826
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287619200000",
    "number": "1104136399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 SE 18TH AVE",
            "address_2": "STE 101",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344718215",
            "telephone_number": "352-622-3360",
            "fax_number": "352-671-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 SE 18TH AVE",
            "address_2": "STE 101",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344718215",
            "telephone_number": "352-622-3360",
            "fax_number": "352-671-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTACKELBERG",
        "first_name": "JARED",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-21",
        "last_updated": "2010-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PAT 9105672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Deshommes, MA
• Desie'S Place
• Tatum Desin
• Robert Desmarais Jr., PMHNP-BC
• Freddy Cyriaque Desormeaux, M.D.
• Jasmine Destefano
• Destiny Adult & Children Counseling Ctr
• Destiny Medical Associates, Inc.
• Olritch Desulme, FNP-BC
• Reddy Mallikarjuna Devarapalli, M.D.

• Physician Assistant in Ocala, FL
• Providers in Ocala, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.