Elizabeth Vidal, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9110762 Issued in FL

Practice address

4020 Winter Garden Vineland Rd Ste 101
Winter Garden, FL 34787

Phone

(407) 993-6120

NPI assigned

Mar 23, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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

Nova Southeastern Univ College of Dental Medicine, 2017

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

• Freedom Health HMO Network
• Optimum HealthCare 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

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Leavitt Medical Associates of Florida Inc

  • Dermatology Physician
  • Ormond Beach, FL
  • NPI 1891953386
  NPD
• Leavitt Medical Associates of Florida Inc

  • Dermatology Physician
  • Heathrow, FL
  • NPI 1528097284

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1205330198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 WINTER GARDEN VINELAND RD",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347879502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 WINTER GARDEN VINELAND RD STE 101",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "34787",
            "telephone_number": "407-993-6120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1503 Buenos Aires Blvd",
            "address_purpose": "LOCATION",
            "city": "The Villages",
            "state": "FL",
            "postal_code": "321596821",
            "country_code": "US",
            "telephone_number": "352-753-2812",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14050 Town Loop Blvd",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328376190",
            "country_code": "US",
            "telephone_number": "407-852-6650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIDAL",
        "first_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-23",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "9110762",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9110762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Winter Garden, FL
• Providers in Winter Garden, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; 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.