Carly Little Conner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9106018 Issued in FL

Practice address

807 Childrens Way
Nemours Childrens Clinic,
Jacksonville, FL 32207-8426

Phone

(904) 697-3600

Fax

(904) 697-3927

NPI assigned

Oct 19, 2011

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 identifiers 1

Other names 1

• Carly Little Other 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

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

May accept Medicare assignment

Group practices

St Vincent'S Full Service Urgent Care, LLCGroup PAC ID 4183879364, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent'S Riverside Hospital, Jacksonville, FL, CCN 100040

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: carly.conner.2@8967.direct.athenahealth.com
• Direct secure messaging: carly.conner.1@8967.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 and National Provider Directory roles.

• St Vincent'S Full Service Urgent Care, LLC

  • Occupational Medicine Clinic/Center
  • Jacksonville, FL
  • NPI 1750672051
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Vincents Medical Center Inc

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1134117575
  Care Compare affiliation
• St. Vincent'S Medical Center, Inc.

  • Clinical Medical Laboratory
  • Jacksonville, FL
  • NPI 1669556072

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1366727596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7963 NORMANDY BLVD",
            "address_2": "PROVIDER ENROLLMENT DEPARTMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322216640",
            "telephone_number": "904-786-0440",
            "fax_number": "904-786-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 CHILDRENS WAY",
            "address_2": "NEMOURS CHILDRENS CLINIC,",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078426",
            "telephone_number": "904-697-3600",
            "fax_number": "904-697-3927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNER",
        "first_name": "CARLY",
        "middle_name": "LITTLE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-19",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA DEPT. OF HEALTH",
            "identifier": "PA9106018",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "LITTLE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Connections Unplugged Inc
• Andria Connell
• Bridget Rose Connell, LAPC
• Linda Connelly
• Amanda Conner
• Cheyenne Conner
• Patrice Conner
• Ann Harouny Connery
• Ann-Marie Colleen Connolly, OD
• Michael Charles Connolly, LMHC

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.