NPIMap

Individual provider Active NPI

Patrick E Ronan, PAC

  • Physician Assistant
  • Port St Lucie, FL
National Provider Identifier
1275520603
Registry record updated Oct 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9103651 Issued in FL
Practice address
1850 SW Fountainview Blvd
Suite 105
Port St Lucie, FL 34986
Phone
(772) 336-2818
Fax
(772) 336-5313
NPI assigned
Sep 30, 2005
Last updated
Oct 8, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2013

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 25MP00083900 NJ
Physician Assistant 363A00000X PA9103651 FL Primary

Addresses

Primary practice location

1850 SW Fountainview Blvd
Suite 105
Port St Lucie, FL 34986

Mailing address

900 S Pine Island Rd
Suite 800
Plantation, FL 33324-3920
Phone (772) 336-2818

Other identifiers 1

IdentifierTypeStateIssuer
292376900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PA9103651FLMDPhysician Assistant
25MP00083900NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saltzman, Tanis, Pittel, Levin and Jacobson Past Accepting new patients
Pelican Pediatrics Past Accepting new patients
Integrated Medical Therapy Group LLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BIGIAD/Endpoint/BIGIAD
  • Direct secure messaging: patrick.ronan@msonimd.directbygreenway.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381190400000",
    "number": "1275520603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S PINE ISLAND RD",
            "address_2": "SUITE 800",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243920",
            "telephone_number": "772-336-2818",
            "fax_number": "772-336-5313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 SW FOUNTAINVIEW BLVD",
            "address_2": "SUITE 105",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "34986",
            "telephone_number": "772-336-2818",
            "fax_number": "772-336-5313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RONAN",
        "first_name": "PATRICK",
        "middle_name": "E",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2013-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00083900",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292376900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.