Individual provider Active NPI

Kenneth Paul Boccaccio, PA-C

  • Physician Assistant
  • Tampa, FL
National Provider Identifier
1194751255
Registry record updated Jan 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
102296 Issued in NC
Practice address
12880 Commodity Place
Tampa, FL 33626-3101
Phone
(813) 343-5500
Fax
(813) 343-5506
NPI assigned
Jun 23, 2006
Last updated
Jan 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2012

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 102296 NC Primary

Addresses

Primary practice location

12880 Commodity Place
Tampa, FL 33626-3101

Mailing address

PO Box 21724
Tampa, FL 33622-1724
Phone (813) 343-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20110216000553 NC Practitioner - Physician Assistant 8729269220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

40 Duke Medicine Cir
Durham, NC 27710-4000
Phone (919) 684-8111

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Duke Health Integrated Practice, Inc. CurrentSince Jul 1, 2023 Accepting new patients
Duke Health Integrated Practice, Inc CurrentSince Jul 1, 2023 Accepting new patients

Locations

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

3400 Wake Forest Rd
Raleigh, NC 27609
Phone (919) 954-3000

4101 Macon Pond Rd
Raleigh, NC 27607
Phone (919) 781-7070

Interoperability endpoints

  • Direct secure messaging: kboccaccio196242@direct.medicine.duke.edu

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

Hospital & facility affiliations 6

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325548800000",
    "number": "1194751255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21724",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336221724",
            "telephone_number": "813-343-5500",
            "fax_number": "813-343-5506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12880 COMMODITY PLACE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336263101",
            "telephone_number": "813-343-5500",
            "fax_number": "813-343-5506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOCCACCIO",
        "first_name": "KENNETH",
        "middle_name": "PAUL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2012-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.