Individual provider Active NPI

Theresa M. Lessard, PA

  • Physician Assistant
  • Palm Coast, FL
National Provider Identifier
1194770503
Registry record updated Dec 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA3189 Issued in FL
Practice address
145 Cypress Point Pkwy
Suite 105
Palm Coast, FL 32164-8426
Phone
(386) 864-9800
NPI assigned
May 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 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 PA3189 FL Primary

Addresses

Primary practice location

145 Cypress Point Pkwy
Suite 105
Palm Coast, FL 32164-8426

Mailing address

PO Box 354034
Palm Coast, FL 32135-4034
Phone (386) 864-9800

Other identifiers 1

IdentifierTypeStateIssuer
291049700MedicaidFL

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Inc Past Accepting new patients
Sterthaus ER SVCS Partnership LLC Past Accepting new patients
Ygeia Health Center Past Accepting new patients
Emcare Physician Providers, Inc. Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356652800000",
    "number": "1194770503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 354034",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321354034",
            "telephone_number": "386-864-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 CYPRESS POINT PKWY",
            "address_2": "SUITE 105",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321648426",
            "telephone_number": "386-864-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESSARD",
        "first_name": "THERESA",
        "middle_name": "M.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2012-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291049700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.