Individual provider Active NPI

Joseph Daniel Sutherland, PA-C

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1255880266
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4675 Issued in TN
Practice address
2501 N Orange Ave Ste 401
Orlando, FL 32804-4644
Phone
(407) 303-5600
NPI assigned
Oct 3, 2016
Last updated
Jun 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 50.005628RX OH
Physician Assistant 363A00000X PA55104 CA
Physician Assistant 363A00000X PA2170 KY
Physician Assistant 363A00000X PA9116537 FL
Physician Assistant 363A00000X 4675 TN Primary

Addresses

Primary practice location

2501 N Orange Ave Ste 401
Orlando, FL 32804-4644

Mailing address

1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 302-6565

Other practice location 1

505 Parnassus Ave
San Francisco, CA 94143-2204
Phone (415) 476-1000

Other practice location 2

800 Rose St
Department of Pediatrics
Lexington, KY 40536-7001
Phone (859) 323-5000

Other practice location 3

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-1121

Other practice location 4

1420 Tusculum Blvd
Greeneville, TN 37745-4279
Phone (423) 787-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, FL, TN, KS4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20171208002644 CA Practitioner - Physician Assistant 8628335114 Reassigns benefits to 1 organization
I20230117003038 FL Practitioner - Physician Assistant 8628335114 Reassigns benefits to 1 organization
I20231019002109 TN Practitioner - Physician Assistant 8628335114 Reassigns benefits to 2 organizations
I20241230003069 KS Practitioner - Physician Assistant 8628335114 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

2700 Dolbeer St
Eureka, CA 95501-4736
Phone (707) 445-8121

2710 Dolbeer St
Eureka, CA 95501-4736
Phone (707) 267-2060

500 Doyle Park Dr
Santa Rosa, CA 95405-4559

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55104CAMDDentist
PA55104CAMDPhysician Assistant
PA9116537FLMDPhysician Assistant
PA2170KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Via Christi Hospital Manhattan, Inc. Physician Assistant CurrentSince Oct 24, 2024 Accepting new patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Jan 16, 2023 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Sep 11, 2023 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Jan 16, 2023 Accepting new patients
Providence Medical Foundation CurrentSince Oct 15, 2023 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Sep 11, 2023 Accepting new patients
Ascension Via Christi Hospital Manhattan, Inc. Current Accepting new patients
Providence Medical Foundation CurrentSince Oct 15, 2023 Accepting new patients
Wellmont Health System Current Accepting new patients
Wellmont Medical Associates Inc Physician Assistant CurrentSince Sep 11, 2023 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Sep 11, 2023 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

2501 N Orange Ave
Ste 401
Orlando, FL 32804

1823 College Ave
Manhattan, KS 66502
Phone (785) 539-1704

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380

1019 W Oakland Ave
Ste 1
Johnson City, TN 37604
Phone (423) 915-5000

1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

Interoperability endpoints

  • Direct secure messaging: jsutherland324720@balladhealth.medalliesdirect.net

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 4

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": "1475452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1255880266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-302-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 N ORANGE AVE STE 401",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328044644",
            "telephone_number": "407-303-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 Parnassus Ave",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941432204",
            "country_code": "US",
            "telephone_number": "415-476-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Rose St",
            "address_2": "Department of Pediatrics",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405367001",
            "country_code": "US",
            "telephone_number": "859-323-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376207430",
            "country_code": "US",
            "telephone_number": "423-844-1121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1420 Tusculum Blvd",
            "address_purpose": "LOCATION",
            "city": "Greeneville",
            "state": "TN",
            "postal_code": "377454279",
            "country_code": "US",
            "telephone_number": "423-787-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUTHERLAND",
        "first_name": "JOSEPH",
        "middle_name": "DANIEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-03",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.005628RX",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA55104",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2170",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116537",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.