Individual provider Active NPI

Mindy Sporn, PA-C

  • Physician Assistant
  • Hollywood, FL
National Provider Identifier
1245304310
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9104258 Issued in FL
Practice address
3501 Johnson St
Hollywood, FL 33021-5421
Phone
(954) 265-9307
NPI assigned
Nov 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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 006974 NY
Physician Assistant 363A00000X PA9104258 FL Primary

Addresses

Primary practice location

3501 Johnson St
Hollywood, FL 33021-5421

Mailing address

5649 Fox Hollow Dr Apt D
Boca Raton, FL 33486-8938

Other identifiers 1

IdentifierTypeStateIssuer
025182100MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address msporn100919@MHSDIRECT.NET

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
I20130214000319 FL Practitioner - Physician Assistant 2668436312 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inphynet Contracting Services LLCGroup PAC ID 7416865811, 169 clinicians

Practice addresses (Care Compare)

3360 Burns Rd
Palm Beach Gardens, FL 33410-4323
Phone (561) 622-1411

3501 Johnson St
Hollywood, FL 33021-5421
Phone (954) 265-2000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Emergency Medicine of Broward LLC CurrentSince Jan 30, 2013 Accepting new patients
Sterling Emergency Services of Florida PA Physician Assistant CurrentSince Apr 27, 2023 Accepting new patients
Sterling Emergency Services of Florida PA Physician Assistant CurrentSince Apr 27, 2023 Accepting new patients
Adventist Health System/Sunbelt Inc. Physician Assistant CurrentSince Aug 1, 2021 Accepting new patients
Adventist Health System/ Sunbelt, Inc. Physician Assistant CurrentSince Aug 1, 2021 Accepting new patients
Urgent Care Centers of Brevard County LLC Physician Assistant CurrentSince Aug 1, 2021 Accepting new patients
Phoenix Emergency Medicine of Broward LLC CurrentSince Jan 30, 2013 Accepting new patients
Beth Israel Medical Center Past Accepting new patients
Beth Israel Medical Center Physician Assistant Past Accepting new patients
St Lukes Roosevelt Hospital Center Physician Assistant Past Accepting new patients
Park Lenox Emergency Medicine, PC Past Accepting new patients

Locations

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

2815 S Seacrest Blvd
Boynton Beach, FL 33435
Phone (561) 732-1277

105 S Banana River Blvd
Cocoa Beach, FL 32931
Phone (321) 783-3362

1600 S Andrews Ave
Ft Lauderdale, FL 33316
Phone (954) 355-4000

901 45th St
Mangonia Park, FL 33407
Phone (561) 844-6300

Interoperability endpoints

  • Direct secure messaging: msporn100919@mhsdirect.net

Organizations & group practices 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1245304310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5649 FOX HOLLOW DR APT D",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334868938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 JOHNSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215421",
            "telephone_number": "954-265-9307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPORN",
        "first_name": "MINDY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "006974",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025182100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msporn100919@MHSDIRECT.NET",
            "affiliation": "N",
            "address_1": "3501 Johnson St",
            "city": "Hollywood",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330215421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.