Active NPI
Tom Pham
- Physician Assistant
- Orlando, FL
National Provider Identifier
1306395090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9109677
- Practice address
- 10743 Narcoossee Rd.
Ste A18
Orlando, FL 32832 - Phone
- (407) 277-1900
- NPI assigned
- Sep 23, 2016
- Last updated
- Feb 24, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9109677 | FL | Primary |
Addresses
Primary practice location
10743 Narcoossee Rd.
Ste A18
Orlando, FL 32832
Mailing address
1743 Narcoossee Rd
Ste A18
Orlando, FL 32832
Phone (407) 277-1900
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251104000148 | FL | Order and Referring Only - Physician Assistant | 9032494166 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9109677 | FL | MD | Physician Assistant |
Interoperability endpoints
- toml.pham@mgbmp-fl.direct.office.nextgen.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487894400000",
"number": "1306395090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1743 NARCOOSSEE RD",
"address_2": "STE A18",
"city": "ORLANDO",
"state": "FL",
"postal_code": "32832",
"telephone_number": "407-277-1900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10743 NARCOOSSEE RD.",
"address_2": "STE A18",
"city": "ORLANDO",
"state": "FL",
"postal_code": "32832",
"telephone_number": "407-277-1900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "TOM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-23",
"last_updated": "2017-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9109677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.