Individual provider Active NPI

Marc Amos Thernelus, PA-C

  • Physician Assistant
  • Maitland, FL
National Provider Identifier
1225611130
Registry record updated Jan 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9113565 Issued in FL
Practice address
2600 Westhall LN
Maitland, FL 32751-7102
Phone
(407) 200-2273
NPI assigned
Apr 29, 2021
Last updated
Jan 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9113565 FL Primary
Medical Physician Assistant 363AM0700X PA9113565 FL

Addresses

Primary practice location

2600 Westhall LN
Maitland, FL 32751-7102

Mailing address

2600 Westhall LN
Maitland, FL 32751-7102

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210624002524 FL Practitioner - Physician Assistant 4183025448 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4001 W Linebaugh Ave
Adventhealth Centra Care Carrollwood
Tampa, FL 33624-5236
Phone (813) 644-6991

440 W Hwy 436
Adventhealth Centra Care Altamonte
Altamonte Springs, FL 32714-4136
Phone (407) 788-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9113565FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health System/Sunbelt Inc. Physician Assistant CurrentSince Nov 28, 2022 Accepting new patients
Adventist Health System/ Sunbelt, Inc. Physician Assistant CurrentSince Nov 28, 2022 Accepting new patients
Florida Medical Clinic, LLC CurrentSince Oct 18, 2021 Accepting new patients
Florida Medical Clinic LLC CurrentSince Oct 18, 2021 Accepting new patients

Locations

440 W State Road 436
Altamonte Springs, FL 32714
Phone (407) 788-2000

2600 Westhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 200-1353

16646 N Dale Mabry Hwy
Tampa, FL 33618
Phone (813) 908-5253

38135 Market Square Dr
Zephyrhills, FL 33542
Phone (352) 567-0188

Interoperability endpoints

  • Direct secure messaging: mthernelus1006319@adventhealth.direct-ci.com

Organizations & group practices 5

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 3

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": "1619654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672617600000",
    "number": "1225611130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 WESTHALL LN",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 WESTHALL LN",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517102",
            "telephone_number": "407-200-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THERNELUS",
        "first_name": "MARC",
        "middle_name": "AMOS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-29",
        "last_updated": "2023-01-02",
        "certification_date": "2023-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9113565",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9113565",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.