Individual provider Active NPI

Nicole Williamson

  • Anesthesiologist Assistant
  • Clearwater, FL
National Provider Identifier
1154903979
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
AA678 Issued in FL
Practice address
3400 Gulf to Bay Blvd
Clearwater, FL 33759-4514
Phone
(813) 574-5200
NPI assigned
Apr 21, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X AA678 FL Primary

Addresses

Primary practice location

3400 Gulf to Bay Blvd
Clearwater, FL 33759-4514

Mailing address

1775 W Hibiscus Blvd Ste 215
Melbourne, FL 32901-2627

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211202000614 FL Practitioner - Anesthesiology Assistant 8224428420 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brevard Physician Associates PLLCGroup PAC ID 1850535048, 221 clinicians

Practice addresses (Care Compare)

1350 Hickory St
Melbourne, FL 32901-3224
Phone (321) 434-7000

Hospital & facility affiliations

  • Holmes Regional Medical Center Hospital, Melbourne, FL, CCN 100019
  • Cape Canaveral Hospital Hospital, Cocoa Beach, FL, CCN 100177
  • Viera Hospital Hospital, Melbourne, FL, CCN 100315
  • Palm Bay Hospital Hospital, Palm Bay, FL, CCN 100316

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Brevard Physician Associates, PLLC Anesthesiologist Assistant CurrentSince Dec 6, 2021 Accepting new patients

Locations

1775 W Hibiscus Blvd
Ste 215
Melbourne, FL 32901
Phone (321) 255-9671

1350 Hickory St
Melbourne, FL 32901
Phone (321) 434-1771

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1154903979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 W HIBISCUS BLVD STE 215",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 GULF TO BAY BLVD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337594514",
            "telephone_number": "813-574-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-21",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "FL",
            "license": "AA678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.