Grace Diana Tice, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9116492 Issued in FL

Practice address

1641 Tamiami TRL Ste 1
Port Charlotte, FL 33948-1018

Phone

(941) 629-6262

NPI assigned

Oct 4, 2022

Sex

Female

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, 2022

Medicare assignment

May accept Medicare assignment

Group practices

Advanced Orthopedic Center of Charlotte County, PAGroup PAC ID 0042106528, 36 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Fawcett Hospital Hospital, Port Charlotte, FL, CCN 100236
• Adventhealth Port Charlotte Hospital, Port Charlotte, FL, CCN 100077
• Desoto Memorial Hospital Hospital, Arcadia, FL, CCN 100175

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: gtice@aoc.emadirect.md

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.

• Advanced Orthopedic Center of Charlotte County, PA

  • Orthopaedic Surgery Physician
  • Port Charlotte, FL
  • NPI 1639177579
  Medicare reassignment Care Compare group
• Advanced Orthopedic Center of Charlotte County, PA

  • Orthopaedic Surgery Physician
  • Venice, FL
  • NPI 1619795317
  NPD

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

• Adventhealth Port Charlotte Inc

  dba Adventhealth Port Charlotte

  • General Acute Care Hospital
  • Port Charlotte, FL
  • NPI 1760299093
  Care Compare affiliation
• Desoto County Hospital District

  dba Desoto Memorial Hospital

  • Rural Acute Care Hospital
  • Arcadia, FL
  • NPI 1528387842
  Care Compare affiliation
• Fawcett Memorial Hospital, Inc.

  dba HCA Florida Fawcett Hospital

  • General Acute Care Hospital
  • Port Charlotte, FL
  • NPI 1417901406
  Care Compare affiliation

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

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1104541937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 AUGUSTA ST E",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339740728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 TAMIAMI TRL STE 1",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481018",
            "telephone_number": "941-629-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICE",
        "first_name": "GRACE",
        "middle_name": "DIANA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-04",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mallory Elora Thompson, OD
• Molly E Thompson, RBT
• Janesha Thornton
• Jennifer Thrall
• Judith A Tiberia, ARNP
• Lisette Tiel Bermudez
• James H Tietsworth, M.D.
• Edward Francis Tilson, PH.D.
• Time Out Respite Care, Inc.
• Candace Timmons, RPH

• Physician Assistant in Port Charlotte, FL
• Providers in Port Charlotte, 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 4, 2022; 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.