NPIMap

Individual provider Active NPI

Christin Pajuelo, APRN

  • Gerontology Nurse Practitioner
  • Melbourne, FL
National Provider Identifier
1144962440
Registry record updated Apr 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APRN11017625 Issued in FL
Practice address
111 E Hibiscus Blvd
Melbourne, FL 32901-3102
Phone
(321) 768-3655
NPI assigned
Apr 8, 2022
Last updated
Apr 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN11017625 FL Primary

Addresses

Primary practice location

111 E Hibiscus Blvd
Melbourne, FL 32901-3102

Mailing address

111 E Hibiscus Blvd
Melbourne, FL 32901-3102
Phone (321) 768-3655

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220615002017 FL Practitioner - Nurse Practitioner 3577942911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Kidney Physicians LLCGroup PAC ID 4385925650, 167 clinicians

Practice addresses (Care Compare)

111 E Hibiscus Blvd
Melbourne, FL 32901-3102
Phone (321) 768-3655

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.33 of 100Reported as group
Quality
70.52
Promoting interoperability
100
Improvement activities
40
Cost
73.91

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN11017625FLMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Kidney Physicians , LLC CurrentSince May 2, 2022 Accepting new patients
Florida Kidney Physicians, LLC CurrentSince May 2, 2022 Accepting new patients
Medical Associates of Brevard LLC Past Accepting new patients

Locations

850 W Rio Salado Pkwy
Ste 201
Tempe, AZ 85281

1150 N 35th Ave
Ste 620
Hollywood, FL 33021
Phone (954) 612-8173

111 E Hibiscus Blvd
Melbourne, FL 32901
Phone (321) 725-8919

14 Suntree Pl
Ste 104
Melbourne, FL 32940
Phone (321) 768-3655

19056 NE 29th Ave
Miami, FL 33180
Phone (305) 354-4558

450 Malabar Rd SE
Palm Bay, FL 32907
Phone (321) 752-3888

450 Malabar Rd SE
Unit 102
Palm Bay, FL 32907
Phone (321) 435-3655

12662 Telecom Dr
Temple Terrace, FL 33637
Phone (813) 910-8708

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: christin.crocker.1@15644.direct.athenahealth.com
  • Direct secure messaging: cpajuelo71466@epicdirect.hf.org
  • FHIR API: https://api.platform.athenahealth.com/15644/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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 7

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": "1649376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680307200000",
    "number": "1144962440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E HIBISCUS BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013102",
            "telephone_number": "321-768-3655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E HIBISCUS BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013102",
            "telephone_number": "321-768-3655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAJUELO",
        "first_name": "CHRISTIN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-08",
        "last_updated": "2023-04-01",
        "certification_date": "2023-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN11017625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.