Montana C Puckett, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

1950 Arlington St Ste 111
Sarasota, FL 34239-3508

Phone

(941) 921-2600

Fax

(941) 925-8672

NPI assigned

Mar 1, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Manatee Specialty Physician Alliance LLCGroup PAC ID 8921473927, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Manatee Memorial Hospital Hospital, Bradenton, FL, CCN 100035

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Networks

• Freedom Health HMO Network

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.

• Manatee Specialty Physician Alliance, LLC

  • Orthopaedic Surgery Physician
  • Bradenton, FL
  • NPI 1881304624
  Medicare reassignment Care Compare group
• Schofield Hand and Bright Orthopaedics PLLC

  • Orthopaedic Surgery Physician
  • Sarasota, FL
  • NPI 1508082983
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Manatee Memorial Hospital L P

  • General Acute Care Hospital
  • Bradenton, FL
  • NPI 1760472799
  Care Compare affiliation

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

{
    "created_epoch": "1646092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1487300265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19701 GULF BLVD UNIT 401",
            "city": "INDIAN SHORES",
            "state": "FL",
            "postal_code": "337852386",
            "telephone_number": "727-743-2276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 ARLINGTON ST STE 111",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342393508",
            "telephone_number": "941-921-2600",
            "fax_number": "941-925-8672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "MONTANA",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-01",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA LICENSE",
            "identifier": "PA9115470",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Publix Super Markets, Inc.
• Publix Super Markets, Inc.
• Publix Super Markets, Inc.
• Publix Super Markets, Inc.
• Sarah Gemma Puccinelli, PA
• Charles A Pue, MD
• Tatiana A. Puerta, DNP, APRN, FNP-BC
• Elizabeth N Pugh
• John Andrew Puleo, M.D.
• Jenilee Perlas Pulido, AU.D

• Surgical Physician Assistant in Sarasota, FL
• Providers in Sarasota, 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 8, 2022; 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.