Individual provider Active NPI

Michael Jenkins

  • Physician Assistant
  • Stuart, FL
National Provider Identifier
1104319300
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112013 Issued in FL
Practice address
1050 SE Monterey Rd Ste 400
Stuart, FL 34994-4512
Phone
(772) 288-2400
NPI assigned
Jun 12, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 022104 NY
Surgical Physician Assistant 363AS0400X NY
Physician Assistant 363A00000X PA9112013 FL Primary

Addresses

Primary practice location

1050 SE Monterey Rd Ste 400
Stuart, FL 34994-4512

Mailing address

229 Parrish St Ste 100
Canandaigua, NY 14424-1791
Phone (661) 350-2508

Other practice location 1

229 Parrish St Ste 100
Canandaigua, NY 14424-1791
Phone (585) 394-1960

Other practice location 2

9401 SW Discovery Way
Port Saint Lucie, FL 34987-2380
Phone (772) 288-2400

Other practice location 3

9401 SW Discovery Way Ste 101
Port Saint Lucie, FL 34987-2381
Phone (772) 288-2400

Other practice location 4

1050 SE Monterey Rd Ste 204
Stuart, FL 34994-4512
Phone (772) 288-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180806001074 NY Practitioner - Physician Assistant 1153679295 Reassigns benefits to 4 organizations
I20221208000959 FL Practitioner - Physician Assistant 1153679295 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meeting House Lane Medical Practice PCGroup PAC ID 6800972589, 125 clinicians

Practice addresses (Care Compare)

240 Meeting House LN
Southampton, NY 11968-5009
Phone (631) 726-8400

325 Meeting House LN
Southampton, NY 11968-7000

3330 Noyac Rd
Sag Harbor, NY 11963-1930
Phone (631) 725-2112

470 Montauk Hwy
East Hampton, NY 11937-2648
Phone (631) 329-5900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
022104NYMDOccupational Therapist
PA9112013FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
South Florida Orthopaedics & Sports Medicine, PA CurrentSince Dec 1, 2022 Accepting new patients
Western New York Medical Practice P.C. CurrentSince Sep 14, 2020 Accepting new patients
Western New York Medical Practice P.C CurrentSince Sep 14, 2020 Accepting new patients
South Florida Orthopaedics & Sports Medicine, PA CurrentSince Dec 1, 2022 Accepting new patients
South Florida Orthopaedics & Sports Medicine,PA Past Accepting new patients

Locations

9401 SW Discovery Way
Ste 101
Port St Lucie, FL 34987
Phone (772) 261-6824

9401 SW Discovery Way
Port St Lucie, FL 34987

1050 SE Monterey Rd
Ste 400
Stuart, FL 34994

1050 SE Monterey Rd
Ste 204
Stuart, FL 34994
Phone (772) 781-5960

229 Parrish St
Ste 100
Canandaigua, NY 14424
Phone (585) 394-0116

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: michael.jenkinspac.p1@direct.southflaortho.nextgenshare.com
  • Direct secure messaging: mjenkins21478@direct.chsbuffalo.org
  • Direct secure messaging: michael.jenkins.p1@direct.shproviders.nextgenshare.com

Organizations & group practices 8

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 6

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": "1528761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1104319300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 PARRISH ST STE 100",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241791",
            "telephone_number": "661-350-2508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 SE MONTEREY RD STE 400",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349944512",
            "telephone_number": "772-288-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "229 Parrish St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Canandaigua",
            "state": "NY",
            "postal_code": "144241791",
            "country_code": "US",
            "telephone_number": "585-394-1960",
            "fax_number": "585-393-9232",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9401 SW Discovery Way",
            "address_purpose": "LOCATION",
            "city": "Port Saint Lucie",
            "state": "FL",
            "postal_code": "349872380",
            "country_code": "US",
            "telephone_number": "772-288-2400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9401 SW Discovery Way Ste 101",
            "address_purpose": "LOCATION",
            "city": "Port Saint Lucie",
            "state": "FL",
            "postal_code": "349872381",
            "country_code": "US",
            "telephone_number": "772-288-2400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 SE Monterey Rd Ste 204",
            "address_purpose": "LOCATION",
            "city": "Stuart",
            "state": "FL",
            "postal_code": "349944512",
            "country_code": "US",
            "telephone_number": "772-288-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-12",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022104",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuart, FL

Sources for this page

Verify at the official NPI Registry.