Eric Agnew, PA-C
Individual provider Active NPI Physician Assistant · Winter Park, FL
NPI 1407209604 · NPPES record last updated Jul 22, 2016
Key facts
- NPI
- 1407209604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PAT9109623 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- 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 Ca
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
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250812001525 | CA | Practitioner - Physician Assistant | 9638457724 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56073 | CA | MD | General Practice Dentistry |
| PAT9109623 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the Univ of Ca | Current |
Accepting new patients | |
| Regents of the Univ of Ca | Current |
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
Ste E
Sacramento, CA 95817
Phone (916) 734-2680
2221 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2680
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PAT9109623 | FL | Yes |
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
Other providers in Winter Park, FL
- Afm Healthcare
- Agape Medical Transporation LLC
- Age Rejuvenation Medical, P.a.
- Monica Aggarwal
- Mohammad Tariq Agha
- Philip Agostinelli
- Margarita Aguayo
- Andrea Agudelo
- Cynthia Aguilar
- Jeremy Aguinaldo
All providers in Winter Park, FL · Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.