Individual provider Active NPI

Cristal Boatright, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1235670621
Registry record updated Aug 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9105271 Issued in FL
Practice address
7741 Point Meadows Dr
Unit 104
Jacksonville, FL 32256-9201
Phone
(904) 660-2330
NPI assigned
Mar 17, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2017

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 PA9105271 FL Primary

Addresses

Primary practice location

7741 Point Meadows Dr
Unit 104
Jacksonville, FL 32256-9201

Mailing address

7741 Point Meadows Dr
Unit 104
Jacksonville, FL 32256-9201
Phone (904) 660-2330

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
I20171019003088 FL Practitioner - Physician Assistant 8022311158 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9105271FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mori Bean and Brooks Inc Physician Assistant Past Accepting new patients
Regional Healthcare Group LLC PastSince Sep 23, 2024 Accepting new patients
Georgia Radiology Imaging Consultants, LLC Past Accepting new patients

Organizations & group practices 4

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": "1489708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503273600000",
    "number": "1235670621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7741 POINT MEADOWS DR",
            "address_2": "UNIT 104",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569201",
            "telephone_number": "904-660-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7741 POINT MEADOWS DR",
            "address_2": "UNIT 104",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569201",
            "telephone_number": "904-660-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOATRIGHT",
        "first_name": "CRISTAL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-17",
        "last_updated": "2017-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.