Individual provider Active NPI

Malcolm Hickox, PA-C

  • Physician Assistant
  • Fernandina Beach, FL
National Provider Identifier
1457385171
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA3003 Issued in FL
Practice address
1132 S 14TH St
Fernandina Beach, FL 32034-2920
Phone
(904) 432-3061
Fax
(904) 432-3062
NPI assigned
Jul 10, 2006
Last updated
Jun 9, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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 PA3003 FL Primary

Addresses

Primary practice location

1132 S 14TH St
Fernandina Beach, FL 32034-2920

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other identifiers 1

IdentifierTypeStateIssuer
290253200MedicaidFL

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
I20100818000378 FL Practitioner - Physician Assistant 5597899161 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians
Solantic of Jacksonville LLCGroup PAC ID 1052409307, 56 clinicians

Practice addresses (Care Compare)

1126 S 14TH St
Fernandina Beach, FL 32034-2920
Phone (904) 432-3061

1128 S 14TH St
Fernandina Beach, FL 32034-2920
Phone (904) 420-6105

1132 S 14TH St
Fernandina Beach, FL 32034-2920
Phone (904) 277-4690

19531 Cochran Blvd
Port Charlotte, FL 33948-2081
Phone (941) 255-3535

463941 Sr
200 Carespot Express Healthcare
Yulee, FL 32097-6342
Phone (615) 600-4074

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Feb 15, 2013 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Feb 15, 2013 Accepting new patients

Locations

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1500 SE 17th St
Ste 600
Ocala, FL 34471
Phone (352) 273-7770

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1457385171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 S 14TH ST",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320342920",
            "telephone_number": "904-432-3061",
            "fax_number": "904-432-3062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKOX",
        "first_name": "MALCOLM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290253200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fernandina Beach, FL

Sources for this page

Verify at the official NPI Registry.