Individual provider Active NPI

Eric Agnew, PA-C

  • Physician Assistant
  • Winter Park, FL
National Provider Identifier
1407209604
Registry record updated Jul 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAT9109623 Issued in FL
Practice address
1605 W Fairbanks Ave
Winter Park, FL 32789-4603
Phone
(407) 975-0200
Fax
(407) 975-0209
NPI assigned
Jul 22, 2016
Last updated
Jul 22, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PAT9109623 FL Primary

Addresses

Primary practice location

1605 W Fairbanks Ave
Winter Park, FL 32789-4603

Mailing address

1605 W Fairbanks Ave
Winter Park, FL 32789-4603
Phone (407) 975-0200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20250812001525 CA Practitioner - Physician Assistant 9638457724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Florida College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the Univ of CaGroup PAC ID 3375456619, 1,571 clinicians

Practice addresses (Care Compare)

2221 Stockton Blvd
Sacramento, CA 95817-1418
Phone (916) 734-2680

2315 Stockton Blvd
Sacramento, CA 95817-2201
Phone (916) 734-2011

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56073CAMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
PAT9109623FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca CurrentSince Jul 16, 2025 Accepting new patients
Regents of the Univ of Ca CurrentSince Jul 16, 2025 Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

10850 White Rock Rd
Rancho Cordova, CA 95670

2221 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2680

2221 Stockton Blvd
Ste E
Sacramento, CA 95817
Phone (916) 734-2680

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469145600000",
    "number": "1407209604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 W FAIRBANKS AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894603",
            "telephone_number": "407-975-0200",
            "fax_number": "407-975-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 W FAIRBANKS AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894603",
            "telephone_number": "407-975-0200",
            "fax_number": "407-975-0209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGNEW",
        "first_name": "ERIC",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-22",
        "last_updated": "2016-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PAT9109623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Park, FL

Sources for this page

Verify at the official NPI Registry.