Individual provider Active NPI

Mark R Winer, PA-C

  • Physician Assistant
  • Sun City Center, FL
National Provider Identifier
1134200470
Registry record updated Oct 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9100908 Issued in FL
Practice address
4031 Upper Creek Dr
Sun City Center, FL 33573-6819
Phone
(813) 634-2733
Fax
(813) 634-8606
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2011

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 PA9100908 FL Primary

Addresses

Primary practice location

4031 Upper Creek Dr
Sun City Center, FL 33573-6819

Mailing address

4031 Upper Creek Dr
Sun City Center, FL 33573-6819
Phone (813) 634-2733

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9100908FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ronald John Heromin M.D.,P.a. Past Accepting new patients
Emergency Medicine of Florida, Inc. Past Accepting new patients

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319760000000",
    "number": "1134200470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4031 UPPER CREEK DR",
            "city": "SUN CITY CENTER",
            "state": "FL",
            "postal_code": "335736819",
            "telephone_number": "813-634-2733",
            "fax_number": "813-634-8606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4031 UPPER CREEK DR",
            "city": "SUN CITY CENTER",
            "state": "FL",
            "postal_code": "335736819",
            "telephone_number": "813-634-2733",
            "fax_number": "813-634-8606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINER",
        "first_name": "MARK",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2011-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9100908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun City Center, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.