Active NPI
Nicole M McCann, PA-C
- Physician Assistant
- Riverview, FL
National Provider Identifier
1487926416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 13005 US Highway 301 S
Riverview, FL 33578-7439 - Phone
- (813) 915-5291
- Fax
- (813) 915-5293
- NPI assigned
- Feb 7, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | FL | Primary |
Addresses
Primary practice location
13005 US Highway 301 S
Riverview, FL 33578-7439
Mailing address
5380 Primrose Lake Cir
Tampa, FL 33647-3589
Phone (813) 769-2778
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003121169B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Nov 8, 2018 through Nov 8, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6365 | GA | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlanta Women'S Health Group, P.C. | Past | Accepting new patients | |
| Pediatric Orthopedic Associates | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Specialist
- Atlanta, GA
- NPI 1174501902
-
- Pediatric Radiology Physician
- Salt Lake City, UT
- NPI 1659488799
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653264000000",
"number": "1487926416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5380 PRIMROSE LAKE CIR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336473589",
"telephone_number": "813-769-2778",
"fax_number": "813-769-2779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13005 US HIGHWAY 301 S",
"city": "RIVERVIEW",
"state": "FL",
"postal_code": "335787439",
"telephone_number": "813-915-5291",
"fax_number": "813-915-5293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCANN",
"first_name": "NICOLE",
"middle_name": "M",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-07",
"last_updated": "2022-05-23",
"certification_date": "2022-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003121169B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.