NPIMap

Individual provider Active NPI

Nicolas Lyde, PA

  • Physician Assistant
  • South Pasadena, FL
National Provider Identifier
1104986355
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA3024 Issued in FL
Practice address
1501 Pasadena Ave S
South Pasadena, FL 33707-3717
Phone
(727) 341-7777
NPI assigned
Dec 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA3024 FL Primary

Addresses

Primary practice location

1501 Pasadena Ave S
South Pasadena, FL 33707-3717

Mailing address

861 SW 78TH Ave
Suite # 100B
Plantation, FL 33324-3273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20150618001522 AZ Practitioner - Physician Assistant 3577469311 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA3024FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Belle Glade Emergency Physicians LLC Past Accepting new patients
Town & Country Emergency Physicians LLC Past Accepting new patients
Floridian Emergency Specialists, LLC PastSince Jan 26, 2020 Accepting new patients
Sebring Emergency Physicians LLC Past Accepting new patients
City Circle ER SVCS Partnership LLC Past Accepting new patients
Palms of Pasadena Emergency Physicians LLC Past Accepting new patients
Tarpon Springs Emergency Physicians, LLC Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104986355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "861 SW 78TH AVE",
            "address_2": "SUITE # 100B",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 PASADENA AVE S",
            "city": "SOUTH PASADENA",
            "state": "FL",
            "postal_code": "337073717",
            "telephone_number": "727-341-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYDE",
        "first_name": "NICOLAS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Pasadena, FL

Sources for this page

Verify at the official NPI Registry.