Tyler Stephanie Passalacqua, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9113012 Issued in FL

Practice address

950 Glades Rd Ste 4a
Boca Raton, FL 33431-6401

Phone

(561) 391-8086

Fax

(954) 418-1698

NPI assigned

May 1, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

Florida International Univ, College of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Complete Local Specialty Care IncGroup PAC ID 3971591231, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Complete Local Specialty Care, Inc

  • Family Medicine Physician
  • Hallandale Beach, FL
  • NPI 1750377453
  Medicare reassignment Care Compare group
• Complete Local Specialty Care, Inc.

  • Family Medicine Physician
  • Boca Raton, FL
  • NPI 1326035312
  NPD

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

{
    "created_epoch": "1588291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1225659147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4855 W HILLSBORO BLVD STE B-2",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "33073",
            "telephone_number": "954-418-1683",
            "fax_number": "954-418-1698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 GLADES RD STE 4A",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334316401",
            "telephone_number": "561-391-8086",
            "fax_number": "954-418-1698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASSALACQUA",
        "first_name": "TYLER",
        "middle_name": "STEPHANIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-01",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9113012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Particle Theory Inc
• Carli Jo Pasawicz
• Ariel Pascual, PA-C
• Howard L Pasekoff, D.M.D.
• Gisele Soledad Pasetti, LMHC
• Passport Health Holdings, LLC
• Stefan Alan Pasternack, M.D.
• Juan Pastor
• Joti Patel, APRN
• Krina Vipul Patel

• Medical Physician Assistant in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; 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.