Individual provider Active NPI

Raquel F Chertman, PAC

  • Physician Assistant
  • Miami, FL
National Provider Identifier
1134420292
Registry record updated Nov 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9105102 Issued in FL
Practice address
1321 NW 14TH Street
Suite 304
Miami, FL 33125
Phone
(305) 324-5481
Fax
(305) 324-7852
NPI assigned
Nov 5, 2010
Last updated
Nov 5, 2010By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2010

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 PA9105102 FL Primary

Addresses

Primary practice location

1321 NW 14TH Street
Suite 304
Miami, FL 33125

Mailing address

1321 NW 14TH Street
Suite 304
Miami, FL 33125
Phone (305) 324-5481

Other identifiers 1

IdentifierTypeStateIssuer
PA9105102OtherFLPA LICENSE

Other names 1

  • Mrs. Raquel Chertman Former name

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
I20160419002535 FL Practitioner - Physician Assistant 3779659453 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9105102FLMDPhysician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1288915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288915200000",
    "number": "1134420292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 NW 14TH STREET",
            "address_2": "SUITE 304",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33125",
            "telephone_number": "305-324-5481",
            "fax_number": "305-324-7852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 NW 14TH STREET",
            "address_2": "SUITE 304",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33125",
            "telephone_number": "305-324-5481",
            "fax_number": "305-324-7852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHERTMAN",
        "first_name": "RAQUEL",
        "middle_name": "F",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-05",
        "last_updated": "2010-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA9105102",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAQUEL",
            "last_name": "CHERTMAN",
            "prefix": "MRS.",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.