Individual provider Active NPI

Michelle Lynn Pendleton, APRN

  • Nurse Practitioner
  • Yulee, FL
National Provider Identifier
1134596802
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN9238670 Issued in FL
Practice address
851042 US Highway 17
Yulee, FL 32097-2845
Phone
(904) 225-3824
Fax
(904) 390-7440
NPI assigned
Aug 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN280179 GA
Family Nurse Practitioner 363LF0000X ARNP9238670 FL
Nurse Practitioner 363L00000X APRN9238670 FL Primary

Addresses

Primary practice location

851042 US Highway 17
Yulee, FL 32097-2845

Mailing address

PO Box 746638
Atlanta, GA 30374-6638
Phone (904) 202-1032

Other identifiers 1

IdentifierTypeStateIssuer
015603300MedicaidFL

Other names 1

  • Michelle Lynn Phillipe Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 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

Enrollment IDStateProvider typePAC IDDetails
I20150929003431 FL Practitioner - Nurse Practitioner 9638487333 Reassigns benefits to 3 organizations
I20181011001965 GA Practitioner - Nurse Practitioner 9638487333 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Primary Care IncGroup PAC ID 0648177733, 459 clinicians

Practice addresses (Care Compare)

851042 US Hwy 17
Yulee, FL 32097-2845
Phone (904) 225-3824

Hospital & facility affiliations

  • Baptist Medical Center - Nassau Hospital, Fernandina Beach, FL, CCN 100140
  • Southeast Georgia Health System -- Camden Campus Hospital, Saint Marys, GA, CCN 110146
  • 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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN9238670FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Sep 14, 2015 Accepting new patients
Baptist Primary Care Inc CurrentSince Sep 10, 2018 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Oct 1, 2015 Accepting new patients
University of Florida Jacksonville Physicians Inc Current Accepting new patients
University of Florida Jacksonville Physicians Inc CurrentSince Sep 14, 2015 Accepting new patients
Baptist Primary Care Inc Nurse Practitioner CurrentSince Sep 10, 2018 Accepting new patients

Locations

45465 Fifth Ave
Callahan, FL 32011
Phone (904) 879-4544

3465 Village Center Dr
Jacksonville, FL 32206
Phone (904) 355-1893

1833 Boulevard
Jacksonville, FL 32206
Phone (904) 244-3289

836 Prudential Dr
Ste 1207
Jacksonville, FL 32207
Phone (904) 396-8656

1255 Lila St
Jacksonville, FL 32208
Phone (904) 244-5700

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

462626 State Road 200
Ste 100
Yulee, FL 32097
Phone (904) 225-3824

851042 US Highway 17
Yulee, FL 32097
Phone (904) 225-3824

2060 Dan Proctor Dr
Ste 3100
Saint Marys, GA 31558
Phone (912) 466-7660

Interoperability endpoints

  • Direct secure messaging: mpendleton20944@baptisthealthsystemjacksonville.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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": "1440720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1134596802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851042 US HIGHWAY 17",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "320972845",
            "telephone_number": "904-225-3824",
            "fax_number": "904-390-7440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDLETON",
        "first_name": "MICHELLE",
        "middle_name": "LYNN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-28",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN280179",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9238670",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN9238670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015603300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "PHILLIPE",
            "middle_name": "LYNN",
            "credential": "ARNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Yulee, FL

Sources for this page

Verify at the official NPI Registry.