Individual provider Active NPI

Crystal Catherine Poma

  • Medical Physician Assistant
  • Brandon, FL
National Provider Identifier
1346954096
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
615 Vonderburg Dr
Brandon, FL 33511-5972
Phone
(813) 662-6200
NPI assigned
Jan 9, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X Primary

Addresses

Primary practice location

615 Vonderburg Dr
Brandon, FL 33511-5972

Mailing address

615 Vonderburg Dr
Brandon, FL 33511-5972
Phone (813) 662-6200

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
I20250123002233 FL Practitioner - Physician Assistant 2466981279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greater Tampa Bay Physician Specialists LLCGroup PAC ID 2961637715, 33 clinicians

Practice addresses (Care Compare)

119 Oakfield Dr
Brandon, FL 33511-5779
Phone (813) 681-5551

2318 Cypress CV
Suite 101
Wesley Chapel, FL 33544-6786
Phone (813) 788-5569

602 S Audubon Ave
Suite a
Tampa, FL 33609-4217
Phone (813) 877-1415

Hospital & facility affiliations

  • HCA Florida Brandon Hospital Hospital, Brandon, FL, CCN 100243

National Provider Directory

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

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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 1

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": "1673222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1346954096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 VONDERBURG DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115972",
            "telephone_number": "813-662-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 VONDERBURG DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115972",
            "telephone_number": "813-662-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POMA",
        "first_name": "CRYSTAL",
        "middle_name": "CATHERINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-09",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.