Individual provider Active NPI

Anneliese Trull, PA-C

  • Medical Physician Assistant
  • Hialeah, FL
National Provider Identifier
1457607160
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9106621 Issued in FL
Practice address
2140 W 68TH St Ste 300
Hialeah, FL 33016-1815
Phone
(305) 822-4107
Fax
(305) 822-5086
NPI assigned
Jul 31, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9106621 FL Primary

Addresses

Primary practice location

2140 W 68TH St Ste 300
Hialeah, FL 33016-1815

Mailing address

2140 W 68TH St Ste 300
Hialeah, FL 33016-1815
Phone (305) 822-4107

Other identifiers 1

IdentifierTypeStateIssuer
PA9106621OtherFLSTATE LICENSE

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
I20121008000538 FL Practitioner - Physician Assistant 5991954992 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Medicine AssociatesGroup PAC ID 3779510102, 17 clinicians

Practice addresses (Care Compare)

2140 W 68 St
Hialeah, FL 33016-1815
Phone (305) 822-4107

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9106621FLMDMedical 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": "1343692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1457607160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 W 68TH ST STE 300",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330161815",
            "telephone_number": "305-822-4107",
            "fax_number": "305-822-5086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 W 68TH ST STE 300",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330161815",
            "telephone_number": "305-822-4107",
            "fax_number": "305-822-5086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRULL",
        "first_name": "ANNELIESE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-31",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA9106621",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.