Michael Mazzoni, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1123046 Issued in TX

Practice address

200 Leese Dr
Saint Johns, FL 32259-6967

Phone

(210) 243-5456

NPI assigned

Dec 9, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Mediq Urgent Care PC

  • Urgent Care Clinic/Center
  • Greensboro, NC
  • NPI 1912381203
  NPD (past)

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418083200000",
    "number": "1295133197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 LEESE DR",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322596967",
            "telephone_number": "210-243-5456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 LEESE DR",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322596967",
            "telephone_number": "210-243-5456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZONI",
        "first_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-09",
        "last_updated": "2014-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "1123046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Sue Matthews, PA-C
• Maxwell Behavioral Health
• Erin Leigh Maxwell, PHARMD
• Gabriela May
• Sarah Mazza, DC
• Sarah Morgan McCroskey
• Willie McFadden Jr.
• Shushana McFarlane
• Leonice McGarvey
• Darnay P McGee, BEHAVIOR TECHNICIAN

• Physician Assistant in Saint Johns, FL
• Providers in Saint Johns, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; 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.