Jack L Cassell M.D. P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME46095 Issued in FL

Legal business name

JACK L CASSELL M.D. P.A.

Practice address

717 N Donnelly St
Mount Dora, FL 32757-4833

Phone

(352) 383-3773

Fax

(352) 383-4434

NPI assigned

Oct 10, 2007

Organization subpart

Yes

Parent organization

JACK L CASSELL M.D. P.A.As reported in NPPES

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

Authorized official

Name

Jack L Cassell, M.D.NPI 1164505483

Title

Owner/Physican

Phone

(352) 383-3773

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Urology of Mount Dora Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Part of

Jack Cassell MD PA

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack L Cassell, MD

  • Urology Physician
  • Mount Dora, FL
  • NPI 1164505483
  Medicare reassignment NPD Authorized official
• Gregory V McIntosh, D.O.

  • Urology Physician
  • Livonia, MI
  • NPI 1184688665
  NPD (past)

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291766400000",
    "number": "1366630808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 N DONNELLY ST",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327574833",
            "telephone_number": "352-383-3773",
            "fax_number": "352-383-4434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 N DONNELLY ST",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327574833",
            "telephone_number": "352-383-3773",
            "fax_number": "352-383-4434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK L CASSELL M.D. P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACK L CASSELL M.D.  P.A.",
        "enumeration_date": "2007-10-10",
        "last_updated": "2010-12-08",
        "status": "A",
        "authorized_official_last_name": "CASSELL",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PHYSICAN",
        "authorized_official_telephone_number": "352-383-3773",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME46095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254899200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urology of Mount Dora",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Integrated Regional Laboratories Pathology Services, LLC
• Ivette Santiago M D P a
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• J&T Divine Care
• J&T Divine Care
• Kimberly T Jackson, DO
• Jaime H Mejia MD PA
• Jaime Penix MD PA
• Janet L Black D P M P a
• Ashley Michelle Jass, CD(DONA)

• Specialist in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.