Individual provider Active NPI

Courtney Zakshevsky, PA

  • Physician Assistant
  • Tampa, FL
National Provider Identifier
1255827630
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9109139 Issued in FL
Practice address
2727 W Dr Martin Luther King Jr Blvd Ste 200
Tampa, FL 33607-6003
Phone
(813) 694-5824
NPI assigned
Jul 9, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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 PA9109139 FL Primary

Addresses

Primary practice location

2727 W Dr Martin Luther King Jr Blvd Ste 200
Tampa, FL 33607-6003

Mailing address

637 Jetstar LN
Oldsmar, FL 34677-5236
Phone (727) 254-9187

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
I20191022002846 FL Practitioner - Physician Assistant 3870825979 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kanan Medical, LLC Past Accepting new patients
Roger E Bassin MD PA PastSince Aug 1, 2007 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14527/brand/1/csg/1/fhir/r4

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": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1255827630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 JETSTAR LN",
            "city": "OLDSMAR",
            "state": "FL",
            "postal_code": "346775236",
            "telephone_number": "727-254-9187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 W DR MARTIN LUTHER KING JR BLVD STE 200",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076003",
            "telephone_number": "813-694-5824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZAKSHEVSKY",
        "first_name": "COURTNEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.