Active NPI
Phillip Michael Gregg, PA-C
- Physician Assistant
- Cape Coral, FL
National Provider Identifier
1164571709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2649
- Practice address
- 1003 Del Prado Blvd S
Suite#101
Cape Coral, FL 33990-3601 - Phone
- (239) 574-4600
- Fax
- (239) 574-2621
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2649 | FL | Primary |
Addresses
Primary practice location
1003 Del Prado Blvd S
Suite#101
Cape Coral, FL 33990-3601
Mailing address
1003 Del Prado Blvd S
Suite#101
Cape Coral, FL 33990-3601
Phone (239) 574-4600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2649 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emcare Physician Providers, Inc. | Past | Accepting new patients | |
| Sterthaus ER SVCS Partnership LLC | Past | Accepting new patients |
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 and National Provider Directory roles.
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- NPI 1376592063
-
- Emergency Medicine Physician
- Daytona Beach, FL
- NPI 1043269376
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407974400000",
"number": "1164571709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1003 DEL PRADO BLVD S",
"address_2": "SUITE#101",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339903601",
"telephone_number": "239-574-4600",
"fax_number": "239-574-2621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1003 DEL PRADO BLVD S",
"address_2": "SUITE#101",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339903601",
"telephone_number": "239-574-4600",
"fax_number": "239-574-2621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREGG",
"first_name": "PHILLIP",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2014-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA2649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cape Coral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.