Individual provider Active NPI

Simi Sahibdin

  • Physician Assistant
  • Winter Park, FL
National Provider Identifier
1336685155
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112520 Issued in FL
Practice address
1573 W Fairbanks Ave Ste 210
Winter Park, FL 32789-4679
Phone
(407) 646-7845
Fax
(407) 646-7846
NPI assigned
Jan 18, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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 010632 NY
Physician Assistant 363A00000X PA9112520 FL Primary

Addresses

Primary practice location

1573 W Fairbanks Ave Ste 210
Winter Park, FL 32789-4679

Mailing address

2800 Marcus Ave
New Hyde Park, NY 11042-1113
Phone (516) 622-6000

Other practice location 1

2800 Marcus Ave
New Hyde Park, NY 11042-1113
Phone (516) 622-7485

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230922000145 FL Practitioner - Physician Assistant 9638410863 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bird and Thornton PAGroup PAC ID 2466577267, 4 clinicians

Practice addresses (Care Compare)

557 N Wymore Rd
Suite 202
Maitland, FL 32751-4200
Phone (407) 855-1073

Hospital & facility affiliations

  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
010632NYMDRegistered Dietitian
PA9112520FLMDPhysician Assistant

Practice roles (3 of 5)

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Nov 6, 2023 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Nov 6, 2023 Accepting new patients
Optum Urgent Care, PLLC Past Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

1573 W Fairbanks Ave
Ste 210
Winter Park, FL 32789
Phone (407) 303-6729

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 4

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 2

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": "1484697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1336685155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 MARCUS AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421113",
            "telephone_number": "516-622-6000",
            "fax_number": "516-622-2914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1573 W FAIRBANKS AVE STE 210",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894679",
            "telephone_number": "407-646-7845",
            "fax_number": "407-646-7846"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 Marcus Ave",
            "address_purpose": "LOCATION",
            "city": "New Hyde Park",
            "state": "NY",
            "postal_code": "110421113",
            "country_code": "US",
            "telephone_number": "516-622-7485",
            "fax_number": "516-622-2914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAHIBDIN",
        "first_name": "SIMI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-18",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "010632",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Park, FL

Sources for this page

Verify at the official NPI Registry.