Alissa Kay Fuentes, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9112799 Issued in FL

Practice address

6169 S Jog Rd Ste B3
Lake Worth, FL 33467-6514

Phone

(561) 433-9191

NPI assigned

Nov 4, 2020

Last updated

Aug 22, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Alissa Kay Broderick Former name

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: alissa.fuentes.2@18731.direct.athenahealth.com

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.

• Dr GS Urgent Care LLC

  • Urgent Care Clinic/Center
  • Delray Beach, FL
  • NPI 1881970168
  Medicare reassignment
• Drug Abuse Foundation

  • Children's Substance Abuse Rehabilitation Facility
  • Delray Beach, FL
  • NPI 1205362712
  NPD (past)
• Drug Abuse Foundation of Palm Beach County, Inc

  • Substance Abuse Rehabilitation Facility
  • Delray Beach, FL
  • NPI 1851557193
  NPD (past)
• Palm Beach Wellness Center LLC

  • Primary Care Clinic/Center
  • Lake Worth, FL
  • NPI 1932415635
  NPD (past)

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

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1306447420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8317 BERMUDA SOUND WAY",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334361729",
            "telephone_number": "786-589-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6169 S JOG RD STE B3",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334676514",
            "telephone_number": "561-433-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUENTES",
        "first_name": "ALISSA",
        "middle_name": "KAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-04",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALISSA",
            "last_name": "BRODERICK",
            "middle_name": "KAY",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Freya Silverstein MD PA Inc
• Neil Friedman, M.D.
• Rachel Emily Friedman
• Sandra Friedman, LCSW
• Annia Friman, RBT
• Yailyn Fuentes
• Andrea Fulcher, LCSW
• Fully Alive Therapies LLC
• Talia Cassey Fundiller
• Leydis Fundora Martin

• Physician Assistant in Lake Worth, FL
• Providers in Lake Worth, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.

Verify at the official NPI Registry.