Individual provider Active NPI

Maria T Petta, P.A.-C.

  • Physician Assistant
  • Weston, FL
National Provider Identifier
1154334704
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9101530 Issued in FL
Practice address
2950 Cleveland Clinic Blvd
Weston, FL 33331-3609
Phone
(954) 659-5290
NPI assigned
Aug 14, 2006
Last updated
Jun 1, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9101530 FL Primary
Medical Physician Assistant 363AM0700X PA9101530 FL
Surgical Physician Assistant 363AS0400X PA9101530 FL

Addresses

Primary practice location

2950 Cleveland Clinic Blvd
Weston, FL 33331-3609

Mailing address

2950 Cleveland Clinic Blvd
Weston, FL 33331-3609
Phone (954) 659-5290

Other identifiers 1

IdentifierTypeStateIssuer
291096900MedicaidFL

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
I20040228000022 FL Practitioner - Physician Assistant 1658268396 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cleveland Clinic FloridaGroup PAC ID 7911807128, 717 clinicians

Practice addresses (Care Compare)

2950 Cleveland Clinic Blvd
Weston, FL 33331-3609
Phone (954) 659-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9101530FLMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cleveland Clinic Florida a Nonprofit Corporation CurrentSince Jul 27, 2015 Accepting new patients
Healthcare Surgical Services, Inc. Surgical Past Accepting new patients

Locations

2950 Cleveland Clinic Blvd
Weston, FL 33331
Phone (954) 689-5000

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 2

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": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464739200000",
    "number": "1154334704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 CLEVELAND CLINIC BLVD",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333313609",
            "telephone_number": "954-659-5290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 CLEVELAND CLINIC BLVD",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333313609",
            "telephone_number": "954-659-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTA",
        "first_name": "MARIA",
        "middle_name": "T",
        "name_prefix": "Ms.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2016-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101530",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9101530",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9101530",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291096900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Weston, FL

Sources for this page

Verify at the official NPI Registry.