Individual provider Active NPI

Jose Elias Mendoza Jr., PA-C

  • Physician Assistant
  • Pembroke Pines, FL
National Provider Identifier
1427488469
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9107468 Issued in FL
Practice address
601 N Flamingo Rd
Suite 108
Pembroke Pines, FL 33028-1015
Phone
(954) 431-7323
NPI assigned
Nov 12, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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 PA9107468 FL Primary

Addresses

Primary practice location

601 N Flamingo Rd
Suite 108
Pembroke Pines, FL 33028-1015

Mailing address

1501 NW 113TH Way
Pembroke Pines, FL 33026-2675
Phone (954) 579-3266

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
I20250318000009 FL Practitioner - Physician Assistant 2668994864 Reassigns benefits to 1 organization

National Provider Directory

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

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": "1384214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1427488469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 NW 113TH WAY",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330262675",
            "telephone_number": "954-579-3266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 N FLAMINGO RD",
            "address_2": "SUITE 108",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330281015",
            "telephone_number": "954-431-7323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "JOSE",
        "middle_name": "ELIAS",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-12",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9107468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.