NPIMap

Individual provider Active NPI

Keith O Coker, PA

  • Medical Physician Assistant
  • Wauchula, FL
National Provider Identifier
1376511451
Registry record updated Aug 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA2367 Issued in FL
Practice address
515 Carlton St
Wauchula, FL 33873-3407
Phone
(863) 773-6606
Fax
(863) 773-9542
NPI assigned
Mar 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA2367 FL Primary

Addresses

Primary practice location

515 Carlton St
Wauchula, FL 33873-3407

Mailing address

515 Carlton St
Wauchula, FL 33873-3407
Phone (863) 773-6606

Other identifiers 2

IdentifierTypeStateIssuer
290003300MedicaidFL
P00003493OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040819001205 FL Practitioner - Physician Assistant 8729052444 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA2367FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health System-Sunbelt Inc CurrentSince Dec 1, 2010 Accepting new patients
Wauchula Hma Physician Management, LLC Past Accepting new patients
Florida Hospital Medical Group Inc Past Accepting new patients
Emergency Medicine of Florida, Inc. Past Accepting new patients
MCR Health, Inc. Past Accepting new patients
Adventist Health System-Sunbelt Inc Medical Past Accepting new patients

Locations

515 Carlton St
Wauchula, FL 33873
Phone (863) 773-6606

Interoperability endpoints

  • Direct secure messaging: kcoker617853@adventhealth.direct-ci.com

Organizations & group practices 12

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 4

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

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adventist Health System-Sunbelt Inc 100 clinicians

Practice addresses (Care Compare)

515 Carlton St
Wauchula, FL 33873-3407
Phone (863) 773-6606

533 Carlton St
Wauchula, FL 33873-3407
Phone (863) 773-3101

Hospital & facility affiliations

  • Aveanna Home Health Home health agency, Bradenton, FL, CCN 109108
  • Adventhealth Home Health Home health agency, Sebring, FL, CCN 107345
  • Adventhealth Wauchula Hospital, Wauchula, FL, CCN 101300
  • Adventhealth Sebring Hospital, Sebring, FL, CCN 100109

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377648000000",
    "number": "1376511451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 CARLTON ST",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338733407",
            "telephone_number": "863-773-6606",
            "fax_number": "863-773-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 CARLTON ST",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338733407",
            "telephone_number": "863-773-6606",
            "fax_number": "863-773-9542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COKER",
        "first_name": "KEITH",
        "middle_name": "O",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2013-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA2367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290003300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00003493",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauchula, FL

Sources for this page

Verify at the official NPI Registry.