Individual provider Active NPI

Jason Sirel, APRN

  • Gerontology Nurse Practitioner
  • Lecanto, FL
National Provider Identifier
1114643152
Registry record updated Nov 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APRN11022181 Issued in FL
Practice address
525 N Dacie PT
Lecanto, FL 34461-8399
Phone
(352) 746-2200
Fax
(352) 746-9320
NPI assigned
Oct 12, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN11022181 FL Primary

Addresses

Primary practice location

525 N Dacie PT
Lecanto, FL 34461-8399

Mailing address

4651 Van Dyke Rd
Lutz, FL 33558-4880
Phone (813) 321-1786

Other identifiers 1

IdentifierTypeStateIssuer
115973000MedicaidFL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20221108001133 FL Practitioner - Nurse Practitioner 0941677710 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11022181FLMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Institute and Skin Cancer Center LLC CurrentSince Mar 25, 2024 Accepting new patients
Douglas K Pierce MD PA PastSince Nov 13, 2022 Accepting new patients

Locations

2783 Brownwood Blvd
The Villages, FL 32163
Phone (352) 834-7546

Organizations & group practices 2

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": "1665532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668211200000",
    "number": "1114643152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4651 VAN DYKE RD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335584880",
            "telephone_number": "813-321-1786",
            "fax_number": "813-321-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N DACIE PT",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344618399",
            "telephone_number": "352-746-2200",
            "fax_number": "352-746-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIREL",
        "first_name": "JASON",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-11-12",
        "certification_date": "2022-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN11022181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115973000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lecanto, FL

Sources for this page

Verify at the official NPI Registry.