Audrey C Sevilla-Ballereau, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9108569 Issued in FL

Practice address

3003 W Dr Martin Luther King Jr Blvd
2ND Mab
Tampa, FL 33607-6307

Phone

(813) 321-6580

Fax

(813) 443-8135

NPI assigned

Jan 8, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Ms. Audrey C Sevilla Former name

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

Mercy College, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baycare Medical Group, Inc.Group PAC ID 6406753623, 1,539 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Josephs Hospital Hospital, Tampa, FL, CCN 100075

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: audreyc.sevillaballereau@direct.mybaycare.org

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.

• Baycare Medical Group, Inc.

  • General Practice Physician
  • Clearwater, FL
  • NPI 1043269871

  Physician Assistant

  Medicare reassignment Care Compare group NPD (past)
• Baycare Medical Group, Inc.

  • Family Medicine Physician
  • Clearwater, FL
  • NPI 1659720837
  NPD
• Baycare Medical Group Pediatric Walk-in Care LLC

  • Pediatrics Physician
  • Lutz, FL
  • NPI 1861850117
  NPD (past)
• Baycare Medical Group Pediatric Walk-in, LLC

  • Pediatrics Physician
  • Tampa, FL
  • NPI 1679724488
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Joseph's Hospital, Inc.

  dba St. Joseph's Women's Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1346519816
  Care Compare affiliation
• St. Joseph's Hospital, Inc.

  dba St. Joseph's Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1881632818
  Care Compare affiliation

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1225213200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 W DR MARTIN LUTHER KING JR BLVD",
            "address_2": "MAB 2ND FLOOR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33607",
            "telephone_number": "813-321-6580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 W DR MARTIN LUTHER KING JR BLVD",
            "address_2": "2ND MAB",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076307",
            "telephone_number": "813-321-6580",
            "fax_number": "813-443-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVILLA-BALLEREAU",
        "first_name": "AUDREY",
        "middle_name": "C",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-08",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108569",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9108569",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GU",
            "license": "PA-070",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014813700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDREY",
            "last_name": "SEVILLA",
            "middle_name": "C",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sever Pusateri & Cortelli MD PA (Florida Eye Center)
• Harry W. Severance Jr., M.D.
• Mary Severino
• Marla E Sevilla Alsina
• Ronaldo Sevilla Berrios
• Drana A. Sexton
• Emerson Sexton, M.S., CCC-SLP
• Wade Sexton, MD
• Annette Keely Seymour
• Marley Megan Seymour, OTD, OTR/L

• Surgical Physician Assistant in Tampa, FL
• Providers in Tampa, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; 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.