Jennifer A Hanley, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9100969 Issued in FL

Practice address

2200 W Eau Gallie Blvd Ste 202B
Melbourne, FL 32935-3166

Phone

(321) 254-7717

Fax

(321) 255-2361

NPI assigned

May 8, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Jennifer Abboud Other name

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

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Associates of Brevard LLCGroup PAC ID 4486558012, 75 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jenniferhanley@mab.medentdirect.com

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.

• Medical Associates of Brevard LLC

  • Multi-Specialty Clinic/Center
  • Melbourne, FL
  • NPI 1861400103
  Medicare reassignment Care Compare group NPD
• Brevard Emergency Services

  • Internal Medicine Physician
  • Melbourne, FL
  • NPI 1104870393
  NPD (past)

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1477502391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 361095",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329361095",
            "telephone_number": "321-254-7717",
            "fax_number": "321-255-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 W EAU GALLIE BLVD STE 202B",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353166",
            "telephone_number": "321-254-7717",
            "fax_number": "321-255-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANLEY",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-08",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9100969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "9287537",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE BCBS#",
            "identifier": "Y04UH",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290574400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "ABBOUD",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sharon Sinangote Haner, DPT
• Jillian Hanford, APRN
• Hanger Prosthetics & Orthotics Inc
• Hanger Prosthetics & Orthotics Inc
• Kerri Hanger, OT
• Leah Hanley
• Mark Raymond Hanley, M.D.
• Michelle Lee Hanley, OTR/L
• Jayde Hanner
• Heather Hansen

• Surgical Physician Assistant in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.