Brent S Mickley, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9103362 Issued in FL

Practice address

14534 Old Saint Augustine Rd Ste 3420
Jacksonville, FL 32258-2616

Phone

(904) 493-8001

Fax

(904) 338-0852

NPI assigned

Jul 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL, NC2 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

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Baptist Cardiology, Inc.Group PAC ID 2466614581, 98 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088

Merit-based Incentive Payment System (MIPS)

Final score

95.44 of 100Reported as apm

Quality

84.21

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bmickley22602@baptisthealthsystemjacksonville.direct-ci.com

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.

• Baptist Cardiology, Inc.

  • Cardiovascular Disease Physician
  • Jacksonville, FL
  • NPI 1760751598
  Medicare reassignment Care Compare group
• Mission Medical Associates, Inc

  • Orthopaedic Surgery Physician
  • Hendersonville, NC
  • NPI 1649772583
  NPD
• DRS Baker & Gilmour MD PA

  • Cardiovascular Disease Physician
  • Jacksonville, FL
  • NPI 1962555490
  NPD (past)

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

• Southern Baptist Hospital of Florida Inc

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1578620449
  Care Compare affiliation

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585612800000",
    "number": "1124034269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43667",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322033667",
            "telephone_number": "904-720-0599",
            "fax_number": "904-376-4036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14534 OLD SAINT AUGUSTINE RD STE 3420",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582616",
            "telephone_number": "904-493-8001",
            "fax_number": "904-338-0852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKLEY",
        "first_name": "BRENT",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05496",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018231000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01718560",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Mickelson, ATC
• Jada Mickens
• Sabrina Mickens
• Melanie Reynolds Mickey, LMHC
• William Robert Mickle, APRN
• John Mickley
• Angelia Rose Miclat
• Victor C. Micolucci, M.D.
• Erik Hayden Middlebrooks, M.D.
• Michael Louis Middlebrooks, D.M.D.

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; 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.