Individual provider Active NPI

Rachalle Boutros Nehmeh, PA-C

  • Physician Assistant
  • Stuart, FL
National Provider Identifier
1417618828
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9118885 Issued in FL
Practice address
10 SE Central Pkwy Ste 100
Stuart, FL 34994-5914
Phone
(772) 303-1101
NPI assigned
Jan 7, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X PA9118885 FL Primary

Addresses

Primary practice location

10 SE Central Pkwy Ste 100
Stuart, FL 34994-5914

Mailing address

3272 SE West Snow Rd
Port Saint Lucie, FL 34984-6527
Phone (772) 203-7286

Other practice location 1

160 NW Central Park Plz Ste 104
Port Saint Lucie, FL 34986-1825
Phone (772) 919-5825

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
I20240904001015 FL Practitioner - Physician Assistant 8123568227 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mindful Medical and Health Services LLCGroup PAC ID 4981097318, 18 clinicians

Practice addresses (Care Compare)

10 SE Central Pkwy
Suite 101
Stuart, FL 34994-5914
Phone (772) 497-5895

145 NW Central Park PLZ
Suite 200
Port St Lucie, FL 34986-2482
Phone (772) 497-5985

National Provider Directory

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

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1417618828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3272 SE WEST SNOW RD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349846527",
            "telephone_number": "772-203-7286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SE CENTRAL PKWY STE 100",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349945914",
            "telephone_number": "772-303-1101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 NW Central Park Plz Ste 104",
            "address_purpose": "LOCATION",
            "city": "Port Saint Lucie",
            "state": "FL",
            "postal_code": "349861825",
            "country_code": "US",
            "telephone_number": "772-919-5825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEHMEH",
        "first_name": "RACHALLE",
        "middle_name": "BOUTROS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-07",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9118885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuart, FL

Sources for this page

Verify at the official NPI Registry.