Alexandra Gabrielle Pack, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9111662 Issued in FL

Practice address

8209 State Road 54
New Port Richey, FL 34655-3016

Phone

(866) 400-3376

Fax

(727) 569-1505

NPI assigned

Sep 14, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Leavitt Medical Associates of Florida IncGroup PAC ID 4688579311, 199 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Leavitt Medical Associates of Florida Inc

  • Dermatology Physician
  • Sebastian, FL
  • NPI 1083872535
  Medicare reassignment Care Compare group NPD
• Leavitt Medical Associates of Florida Inc

  • Dermatology Physician
  • Palm Coast, FL
  • NPI 1902067671
  NPD
• Leavitt Medical Associates of Florida Inc

  • Dermatology Physician
  • Heathrow, FL
  • NPI 1528097284
  NPD (past)

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

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1164905196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172",
            "telephone_number": "866-400-3376",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8209 STATE ROAD 54",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346553016",
            "telephone_number": "866-400-3376",
            "fax_number": "727-569-1505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "ALEXANDRA",
        "middle_name": "GABRIELLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-14",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Our Lady of Mercy Clinic LLC
• Kylie Carter Owens, MSW
• Robert Michael Owens
• Pablo Dialysis LLC
• Christopher P Pace
• Stephanie Lauren Packrall, RD, LD, CLC
• Jonathan Pagano, LMHC, CRC
• Edward Lloyd Paikoff, D.D.S.
• Palm Harbor Spine Center Inc
• Anastasia Maria Palmer, PHARMD, RPH

• Physician Assistant in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.