Individual provider Active NPI

Dean J Zimmermann, PA-C

  • Physician Assistant
  • St Augustine, FL
National Provider Identifier
1417580416
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112964 Issued in FL
Practice address
240 Southpark Cir E
Saint Augustine, FL 32086-5137
Phone
(904) 824-1450
NPI assigned
Feb 18, 2020
Last updated
Dec 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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 PA9112964 FL Primary

Addresses

Primary practice location

240 Southpark Cir E
Saint Augustine, FL 32086-5137

Mailing address

12109 County Road 103
Oxford, FL 34484-2951
Phone (352) 205-8981

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200331003660 FL Practitioner - Physician Assistant 7719316405 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Urology Institute LLCGroup PAC ID 2163653585, 152 clinicians

Practice addresses (Care Compare)

506 Palmetto St
New Smyrna Beach, FL 32168-7325
Phone (386) 427-9554

545 Health Blvd
Daytona Beach, FL 32114-1493
Phone (386) 239-8500

609 W Highland Blvd
Inverness, FL 34452-4638
Phone (352) 726-9707

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.09 of 100Reported as group
Promoting interoperability
100
Improvement activities
40
Cost
80.3

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Urology Institute, LLC CurrentSince Feb 18, 2020 Accepting new patients
Atlantic Coast Urology,PA Current Accepting new patients
Advanced Urology Institute, LLC CurrentSince Feb 18, 2020 Accepting new patients
Advanced Urology Institute LLC Past Accepting new patients

Locations

609 W Highland Blvd
Inverness, FL 34452
Phone (352) 726-9707

506 Palmetto St
New Smyrna Beach, FL 32168
Phone (386) 427-9554

12109 County Road 103
Oxford, FL 34484
Phone (352) 205-8981

113 Whitehall Dr
St Augustine, FL 32086
Phone (904) 824-1450

240 Southpark Cir E
St Augustine, FL 32086
Phone (904) 824-1450

Interoperability endpoints

  • Direct secure messaging: deanzimmermann@acuro.medalliesdirect.net
  • Direct secure messaging: dzimmermann744192@direct.shands.ufl.edu
  • FHIR API: https://app.meldrx.com/api/fhir/uc41222_advuroswflorida

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1417580416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12109 COUNTY ROAD 103",
            "city": "OXFORD",
            "state": "FL",
            "postal_code": "344842951",
            "telephone_number": "352-205-8981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 SOUTHPARK CIR E",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320865137",
            "telephone_number": "904-824-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMANN",
        "first_name": "DEAN",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-18",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.