NPIMap

Individual provider Active NPI

Jason Nagel, PA

  • Physician Assistant
  • Melbourne, FL
National Provider Identifier
1194775882
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAT9103432 Issued in FL
Practice address
250 N Wickham Rd
Melbourne, FL 32935-8625
Phone
(800) 476-8646
Fax
(919) 382-3210
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 PAT9103432 FL Primary

Addresses

Primary practice location

250 N Wickham Rd
Melbourne, FL 32935-8625

Mailing address

PO Box 552205
Tampa, FL 33655-0001
Phone (800) 476-8646

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060302000101 FL Practitioner - Physician Assistant 6800802703 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PAT9103432FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
FL-I Medical Services, LLC Physician Assistant CurrentSince Jul 26, 2021 Accepting new patients
Sterthaus ER SVCS Partnership LLC Past Accepting new patients
Wuesthoff Emergency Physicians PA Past Accepting new patients
Osprey Emergency Physicians LLC Past Accepting new patients
Florida Em-I Medical Services PA Past Accepting new patients
Wuesthoff Emergency Physicians-Melbourne PA Past Accepting new patients
Clover Emergency Physicians LLC Past Accepting new patients

Locations

2020 59th St W
Bradenton, FL 34209
Phone (813) 798-6303

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 10

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194775882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 552205",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336550001",
            "telephone_number": "800-476-8646",
            "fax_number": "919-382-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358625",
            "telephone_number": "800-476-8646",
            "fax_number": "919-382-3210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAGEL",
        "first_name": "JASON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PAT9103432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.