Individual provider Active NPI

Patricia Lewis, A.P.R.N.

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • St Augustine, FL
National Provider Identifier
1427154624
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0809X
License
162923 Issued in MA
Practice address
13 Marilyn Ave
St Augustine, FL 32080-5345
Phone
(617) 407-6527
NPI assigned
Sep 15, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 364SP0809X 162923 MA Primary

Addresses

Primary practice location

13 Marilyn Ave
St Augustine, FL 32080-5345

Mailing address

13 Marilyn Ave
St Augustine, FL 32080-5345
Phone (617) 407-6527

Other names 1

  • Patricia Shutt Former name

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
I20220518000241 FL Practitioner - Certified Clinical Nurse Specialist (CNS) 4981504297 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
162923MAMDAdult Psychiatric/Mental Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Center for TMS Single Specialty CurrentSince Feb 8, 2022 Accepting new patients
President & Fellows of Harvard College Single Specialty Past Accepting new patients
President and Fellows of Harvard College Past Accepting new patients

Locations

17 Saint Johns Medical Park Dr
St Augustine, FL 32086
Phone (904) 429-7076

Organizations & group practices 3

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": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1427154624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 MARILYN AVE",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320805345",
            "telephone_number": "617-407-6527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 MARILYN AVE",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320805345",
            "telephone_number": "617-407-6527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "PATRICIA",
        "name_prefix": "Dr.",
        "credential": "A.P.R.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0809X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "MA",
            "license": "162923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PATRICIA",
            "last_name": "SHUTT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.