Individual provider Active NPI

Marica Ilich, PA-C, ATC, LAT

  • Physician Assistant
  • Miami Gardens, FL
National Provider Identifier
1194198770
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9117586 Issued in FL
Practice address
19955 NW 27TH Ave Ste 200
Miami Gardens, FL 33056-2675
Phone
(786) 268-6200
NPI assigned
Nov 4, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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 PA9117586 FL Primary

Addresses

Primary practice location

19955 NW 27TH Ave Ste 200
Miami Gardens, FL 33056-2675

Mailing address

PO Box 100905
Atlanta, GA 30384-0905
Phone (786) 595-1310

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address MAR09143@cerner.directbaptisthealth.com

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
I20230824000126 FL Practitioner - Physician Assistant 7911360946 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1150 Campo Sano Ave
Coral Gables, FL 33146-1174
Phone (786) 268-6200

19955 NW 27TH Ave
Suite 200
Miami Gardens, FL 33056-2675
Phone (786) 595-1310

6200 SW 73 St
South Miami, FL 33143-4679
Phone (786) 662-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.58 of 100Reported as group
Quality
72.08
Promoting interoperability
99
Improvement activities
40
Cost
74.01

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9117586FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Orthopedics, LLC CurrentSince Aug 9, 2023 Accepting new patients
Baptist Health Medical Group Orthopedics, LLC CurrentSince Aug 9, 2023 Accepting new patients

Locations

1150 Campo Sano Ave
Ste 200
Miami, FL 33146
Phone (305) 669-3320

19955 NW 27th Ave
Ste 200
Miami Gardens, FL 33056
Phone (786) 595-1310

1228 S Pine Island Rd
Ste 310
Plantation, FL 33324
Phone (954) 392-1725

6200 SW 73rd St
South Miami, FL 33143
Phone (305) 661-4611

Interoperability endpoints

  • Direct secure messaging: mar09143@cerner.directbaptisthealth.com

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.

Hospital & facility affiliations 1

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": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1194198770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100905",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303840905",
            "telephone_number": "786-595-1310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19955 NW 27TH AVE STE 200",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330562675",
            "telephone_number": "786-268-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILICH",
        "first_name": "MARICA",
        "credential": "PA-C, ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-04",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9117586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MAR09143@cerner.directbaptisthealth.com",
            "affiliation": "N",
            "address_1": "19955 NW 27th Ave Ste 200",
            "city": "Miami Gardens",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330562675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Miami Gardens, FL

Sources for this page

Verify at the official NPI Registry.