Individual provider Active NPI

Jasmine Siska, PA-C

  • Medical Physician Assistant
  • Brandon, FL
National Provider Identifier
1447665377
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9110151 Issued in FL
Practice address
1721 Brandon Main St Ste a
Brandon, FL 33511-5018
Phone
(813) 315-1530
Fax
(813) 355-5909
NPI assigned
Jun 30, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0110004618 VA
Medical Physician Assistant 363AM0700X PA9110151 FL Primary

Addresses

Primary practice location

1721 Brandon Main St Ste a
Brandon, FL 33511-5018

Mailing address

38135 Market SQ
Zephyrhills, FL 33542-7505
Phone (352) 567-0188

Other identifiers 1

IdentifierTypeStateIssuer
022259200MedicaidFL

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
I20171020002445 FL Practitioner - Physician Assistant 7911223029 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ohi West Medical Group II LLCGroup PAC ID 0648631192, 407 clinicians

Practice addresses (Care Compare)

1721 Brandon Main St
Brandon, FL 33511-5018

38101 Market Square Dr
Zephyrhills, FL 33542-7505
Phone (813) 715-0195

38103 Market Square Dr
Zephyrhills, FL 33542-7505
Phone (813) 778-0414

38105 Market Square Dr
Zephyrhills, FL 33542-7505
Phone (813) 815-5380

38107 Market Square Dr
Zephyrhills, FL 33542-7505
Phone (813) 979-0440

38135 Market Square Dr
Zephyrhills, FL 33542-7505

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9110151FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Medical Clinic LLC CurrentSince Oct 2, 2017 Accepting new patients
Florida Medical Clinic, LLC CurrentSince Oct 2, 2017 Accepting new patients
Ohi West Medical Group II LLC CurrentSince Apr 1, 2024 Accepting new patients
Ohi West Medical Group II LLC CurrentSince Apr 1, 2024 Accepting new patients

Locations

1721 Brandon Main St
Ste A
Brandon, FL 33511
Phone (813) 315-1530

6037 Winthrop Commerce Ave
Ste 201
Riverview, FL 33578
Phone (813) 677-8418

38135 Market Square Dr
Zephyrhills, FL 33542
Phone (352) 567-0188

38135 Market Square Dr
Ste 101
Zephyrhills, FL 33542
Phone (813) 788-7651

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1447665377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38135 MARKET SQ",
            "city": "ZEPHYRHILLS",
            "state": "FL",
            "postal_code": "335427505",
            "telephone_number": "352-567-0188",
            "fax_number": "813-355-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 BRANDON MAIN ST STE A",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115018",
            "telephone_number": "813-315-1530",
            "fax_number": "813-355-5909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISKA",
        "first_name": "JASMINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-30",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0110004618",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9110151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022259200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.