NPIMap

Individual provider Active NPI

Grace Pagtakhan, NP-C

  • Family Nurse Practitioner
  • Orlando, FL
National Provider Identifier
1295185676
Registry record updated May 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9484394 Issued in FL
Practice address
7400 Docs Grove Cir
Orlando, FL 32819
Phone
(407) 352-9717
Fax
(407) 354-5425
NPI assigned
Jun 16, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024173648 VA
Family Nurse Practitioner 363LF0000X 9484394 FL Primary

Addresses

Primary practice location

7400 Docs Grove Cir
Orlando, FL 32819

Mailing address

7400 Docs Grove Cir
Orlando, FL 32819-8010
Phone (407) 352-9717

Other practice location 1

1380 Tuscany Dr
Virginia Beach, VA 23456-7751
Phone (757) 252-9800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160907001468 VA Practitioner - Nurse Practitioner 2961798616 Reassigns benefits to 1 organization
I20180911001187 FL Practitioner - Nurse Practitioner 2961798616

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bon Secours Medical Group Hampton Roads Primary Care LLCGroup PAC ID 0941632756, 62 clinicians

Practice addresses (Care Compare)

2897 Bridge Rd
Suffolk, VA 23435-1799
Phone (757) 484-7248

3537 Airline Blvd
Suite 1
Portsmouth, VA 23701-2650
Phone (757) 738-1225

828 Healthy Way
Suite 220
Virginia Beach, VA 23462-7960
Phone (757) 305-1797

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9484394FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Hampton Roads Primary Care LLC CurrentSince Jan 1, 2022 Accepting new patients

Locations

3537 Airline Blvd
Ste 1
Portsmouth, VA 23701
Phone (757) 738-1225

8580 Magellan Pkwy
Richmond, VA 23227
Phone (804) 627-5462

5818 Harbour View Blvd
Ste 250
Suffolk, VA 23435
Phone (757) 673-5890

2897 Bridge Rd
Suffolk, VA 23435
Phone (757) 484-7248

5838 Harbour View Blvd
Ste 270
Suffolk, VA 23435
Phone (757) 541-1050

Interoperability endpoints

  • Direct secure messaging: gpagtakhan1154419@direct.bsmhealth.org

Organizations & group practices 1

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.

Hospital & facility affiliations 10

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": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557878400000",
    "number": "1295185676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 DOCS GROVE CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198010",
            "telephone_number": "407-352-9717",
            "fax_number": "407-354-5425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 DOCS GROVE CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32819",
            "telephone_number": "407-352-9717",
            "fax_number": "407-354-5425"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1380 Tuscany Dr",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234567751",
            "country_code": "US",
            "telephone_number": "757-252-9800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAGTAKHAN",
        "first_name": "GRACE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-16",
        "last_updated": "2019-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024173648",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9484394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.