Individual provider Active NPI

Rustin G Sorensen, PA-C

  • Surgical Physician Assistant
  • Niceville, FL
National Provider Identifier
1164433827
Registry record updated Jan 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9101453 Issued in FL
Practice address
1950 Bluewater Blvd
Suite 100
Niceville, FL 32578
Phone
(850) 897-8081
Fax
(850) 897-3846
NPI assigned
Aug 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA9101453 FL Primary

Addresses

Primary practice location

1950 Bluewater Blvd
Suite 100
Niceville, FL 32578

Mailing address

1950 Bluewater Blvd
Suite 100
Niceville, FL 32578
Phone (850) 897-8081

Other identifiers 1

IdentifierTypeStateIssuer
970023871OtherFLRRMC

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
I20100316000952 FL Practitioner - Physician Assistant 6901931930 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of South Alabama College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Florida Surgeons PAGroup PAC ID 2769381391, 336 clinicians

Practice addresses (Care Compare)

11945 San Jose Blvd
Jacksonville, FL 32223-1627
Phone (904) 396-1725

36474 C Emerald Coast Pkwy
Suite 3101
Destin, FL 32541-6701
Phone (850) 344-1646

5300 S Ferdon Blvd
Crestview, FL 32536-5235
Phone (850) 344-1646

554 Twin Cities Blvd
Suite D
Niceville, FL 32578-1058
Phone (850) 344-1646

Hospital & facility affiliations

  • Sacred Heart Hospital on the Emerald Coast Hospital, Miramar Beach, FL, CCN 100292
  • HCA Florida Fort Walton-Destin Hospital Hospital, Fort Walton Beach, FL, CCN 100223
  • HCA Florida Twin Cities Hospital Hospital, Niceville, FL, CCN 100054

Merit-based Incentive Payment System (MIPS)

Final score
81.79 of 100Reported as group
Quality
64.42
Promoting interoperability
100
Improvement activities
40
Cost
74.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9101453FLMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Florida Surgeons, PA CurrentSince Oct 1, 2023 Accepting new patients
North Florida Surgeons, PA CurrentSince Oct 1, 2023 Accepting new patients
Bluewater Orthopedics PA CurrentSince Aug 14, 2000 Accepting new patients
Bluewater Orthopedics, P.a. CurrentSince Aug 14, 2000 Accepting new patients
Orthopaedic Associates, PA Past Accepting new patients

Locations

5300 S Ferdon Blvd
Crestview, FL 32536
Phone (850) 344-1646

36474C Emerald Coast Pkwy
Ste 3101
Destin, FL 32541
Phone (850) 344-1646

1034 Mar Walt Dr
Unit 100
Ft Walton Bch, FL 32547
Phone (850) 315-9210

1034 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 344-1646

11945 San Jose Blvd
Ste 102
Jacksonville, FL 32223
Phone (904) 268-3937

11945 San Jose Blvd
Ste 300
Jacksonville, FL 32223

1950 Bluewater Blvd
Ste 100
Niceville, FL 32578
Phone (850) 897-8081

554 Twin Cities Blvd
Ste D
Niceville, FL 32578
Phone (850) 315-9210

1827 Harrison Ave
Panama City, FL 32405
Phone (850) 785-4344

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23855/brand/1/csg/1/fhir/r4
  • Direct secure messaging: rustin.sorensen.1@9109.direct.athenahealth.com
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264550400000",
    "number": "1164433827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 BLUEWATER BLVD",
            "address_2": "SUITE 100",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "32578",
            "telephone_number": "850-897-8081",
            "fax_number": "850-897-3846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 BLUEWATER BLVD",
            "address_2": "SUITE 100",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "32578",
            "telephone_number": "850-897-8081",
            "fax_number": "850-897-3846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SORENSEN",
        "first_name": "RUSTIN",
        "middle_name": "G",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2010-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9101453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "970023871",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

Verify at the official NPI Registry.