Individual provider Active NPI

Daniel C Chin, PA

  • Medical Physician Assistant
  • Clermont, FL
National Provider Identifier
1134595879
Registry record updated May 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9114405 Issued in FL
Practice address
1920 Don Wickham Dr
Clermont, FL 34711-1918
Phone
(352) 536-8761
Fax
(352) 843-2120
NPI assigned
Aug 17, 2015
Last updated
May 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 018936 NY
Medical Physician Assistant 363AM0700X PA9114405 FL Primary

Addresses

Primary practice location

1920 Don Wickham Dr
Clermont, FL 34711-1918

Mailing address

1920 Don Wickham Dr
Clermont, FL 34711-1918
Phone (352) 536-8761

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
I20230518000119 FL Practitioner - Physician Assistant 2860795549 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

1900 Don Wickham Dr
Clermont, FL 34711-1979

32 W Gore St
Orlando, FL 32806-1134

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9114405FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Apr 1, 2023 Accepting new patients

Locations

1920 Don Wickham Dr
Clermont, FL 34711
Phone (352) 243-5891

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1439769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683331200000",
    "number": "1134595879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 DON WICKHAM DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111918",
            "telephone_number": "352-536-8761",
            "fax_number": "352-843-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 DON WICKHAM DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111918",
            "telephone_number": "352-536-8761",
            "fax_number": "352-843-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHIN",
        "first_name": "DANIEL",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-17",
        "last_updated": "2023-05-06",
        "certification_date": "2023-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "018936",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9114405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

Verify at the official NPI Registry.