Individual provider Active NPI

Yasmine Faisal Haidar, PA-C

  • Physician Assistant
  • New Smyrna Beach, FL
National Provider Identifier
1114719333
Registry record updated Jun 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
617 Canal St Ste 110
New Smyrna Beach, FL 32168-6901
Phone
(386) 734-9122
NPI assigned
May 22, 2025
Last updated
Jun 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2025

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 Primary

Addresses

Primary practice location

617 Canal St Ste 110
New Smyrna Beach, FL 32168-6901

Mailing address

740 W Plymouth Ave
Deland, FL 32720-3282
Phone (386) 734-9122

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
I20250623001880 FL Practitioner - Physician Assistant 8123530565 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

617 Canal St
Suite 110
New Smyrna, FL 32168-6901
Phone (386) 734-9122

740 W Plymouth Ave
Deland, FL 32720-3282
Phone 38673491221040

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Orthopaedic Associates PA CurrentSince Jun 9, 2025 Accepting new patients
Tallahassee Orthopedic Clinic III PL CurrentSince Feb 1, 2026 Accepting new patients
Tallahassee Orthopedic Clinic III, P.L. CurrentSince Feb 1, 2026 Accepting new patients

Locations

740 W Plymouth Ave
Deland, FL 32720
Phone (386) 734-9122

617 Canal St
Ste 110
New Smyrna Beach, FL 32168
Phone (386) 734-9122

1053 Medical Center Dr
Ste 101
Orange City, FL 32763
Phone (386) 744-2500

3334 Capital Medical Blvd
Tallahassee, FL 32308
Phone (229) 393-5185

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: yasmine.haidar.1@29635.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1747872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750118400000",
    "number": "1114719333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 W PLYMOUTH AVE",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327203282",
            "telephone_number": "386-734-9122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 CANAL ST STE 110",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686901",
            "telephone_number": "386-734-9122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAIDAR",
        "first_name": "YASMINE",
        "middle_name": "FAISAL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-22",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Smyrna Beach, FL

Sources for this page

Verify at the official NPI Registry.