Individual provider Active NPI

Kendra Jean Primavera, PA-C

  • Physician Assistant
  • Boca Raton, FL
National Provider Identifier
1457004889
Registry record updated Jan 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9117930 Issued in FL
Practice address
670 Glades Rd Ste 200
Boca Raton, FL 33431-6464
Phone
(561) 495-9511
NPI assigned
Jan 26, 2022
Last updated
Jan 7, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2026

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 PA9117930 FL Primary

Addresses

Primary practice location

670 Glades Rd Ste 200
Boca Raton, FL 33431-6464

Mailing address

670 Glades Rd Ste 200
Boca Raton, FL 33431-6464
Phone (561) 495-9511

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
I20231030003694 FL Practitioner - Physician Assistant 6305292145 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rehabclinics Pta IncGroup PAC ID 0547237497, shared by 11 NPIs, 209 clinicians
Florida Spine Associates LLCGroup PAC ID 8426402819, 20 clinicians
Cora Health Services IncGroup PAC ID 1759290992, shared by 21 NPIs, 1,125 clinicians

Practice addresses (Care Compare)

1817 E Commercial Blvd
Ft Lauderdale, FL 33308-3767
Phone (954) 836-8980

670 Glades Rd
Suite 200
Boca Raton, FL 33431-6464
Phone (561) 495-9511

7015 Beracasa Way
Cora Physical Therapy W Boca Raton
Boca Raton, FL 33433-3453
Phone (561) 939-2033

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Spine Associates LLC CurrentSince Oct 1, 2023 Accepting new patients
Ortho Florida, LLC Past Accepting new patients

Locations

670 Glades Rd
Ste 200
Boca Raton, FL 33431
Phone (561) 391-6470

1414 SE 3rd Ave
Ft Lauderdale, FL 33316
Phone (954) 764-8033

Organizations & group practices 2

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 6

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": "1643155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767744000000",
    "number": "1457004889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 GLADES RD STE 200",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334316464",
            "telephone_number": "561-495-9511",
            "fax_number": "561-990-7426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 GLADES RD STE 200",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334316464",
            "telephone_number": "561-495-9511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIMAVERA",
        "first_name": "KENDRA",
        "middle_name": "JEAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-26",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9117930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.