Individual provider Active NPI

Rebecca Lynn Gicewicz, PA C

  • Physician Assistant
  • Panama City, FL
National Provider Identifier
1164453965
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 3519 Issued in FL
Practice address
402 W 19TH St
Panama City, FL 32405-4602
Phone
(850) 763-6179
Fax
(850) 763-0412
NPI assigned
Jul 6, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 3519 FL Primary

Addresses

Primary practice location

402 W 19TH St
Panama City, FL 32405-4602

Mailing address

402 W 19TH St
Panama City, FL 32405-4602
Phone (850) 763-6179

Other identifiers 1

IdentifierTypeStateIssuer
04095OtherFLBCBS OF FL

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
I20100114000335 FL Practitioner - Physician Assistant 6204977176 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA 3519FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Michael W Reed MD PA Past Accepting new patients
Emerald Coast Hospitalist Inc Past Accepting new patients
Emerald Waters Inpatient Services LLC Past Accepting new patients
A O Rifai MD LLC Past Accepting new patients
Bayne Jones Army Community Hospital PastSince Mar 29, 2020 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164453965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 W 19TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054602",
            "telephone_number": "850-763-6179",
            "fax_number": "850-763-0412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 W 19TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054602",
            "telephone_number": "850-763-6179",
            "fax_number": "850-763-0412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GICEWICZ",
        "first_name": "REBECCA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 3519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "04095",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

Verify at the official NPI Registry.