Jessy Diaz, PA-C
Individual provider Active NPI Medical Physician Assistant · Pinecrest, FL
NPI 1487955902 · NPPES record last updated Mar 30, 2017
Key facts
- NPI
- 1487955902
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA9105581 (FL)
- Practice address
- 7700 SW 104TH St
Suite 201
Pinecrest, FL 33156-3149 - Phone
- (305) 279-7546
- NPI assigned
- Nov 15, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121227000123 | FL | Practitioner - Physician Assistant | 1456504406 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9105581 | FL | MD | Medical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA9105581 | FL | Yes |
Addresses
Primary practice location
7700 SW 104TH St
Suite 201
Pinecrest, FL 33156-3149
Mailing address
7700 SW 104TH St
Pinecrest, FL 33156-3149
Phone (305) 279-7546
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA9105581 | Other | FL | PHYSICIAN ASSISTANT LICENSE |
Other providers in Pinecrest, FL
- Vincent Del Rosario
- Samantha Delgado
- Emily Deutch
- Damian Antonio Diaz Cotelo
- Alejandro Diaz
- Dr. Medina'S Optical, LLC.
- Zoryana Dudaryk
- Mark Richard Dylewski
- Ramses Echevarria
- Katerina Eguino
All providers in Pinecrest, FL · Medical Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.