Individual provider Active NPI

Gabrielle Eneman-Becker, PA-C

  • Physician Assistant
  • Plantation, FL
National Provider Identifier
1497030571
Registry record updated Jul 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9105117 Issued in FL
Practice address
9611 W Broward Blvd
Plantation, FL 33324-2334
Phone
(954) 924-7000
NPI assigned
Oct 20, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9105117 FL
Physician Assistant 363A00000X PA9105117 FL Primary

Addresses

Primary practice location

9611 W Broward Blvd
Plantation, FL 33324-2334

Mailing address

900 S Pine Island Rd
Suite 800
Plantation, FL 33324-3920
Phone (305) 940-6016

Other practice location 1

4972 Town Center Pkwy
Jacksonville, FL 32246-8595
Phone (904) 642-6100

Other practice location 2

11260 Sullivan St
Riverview, FL 33578-2140
Phone (813) 689-7571

Other practice location 3

1610 NE Miami Gardens Dr
North Miami Beach, FL 33179-4900
Phone (305) 940-6016

Other identifiers 1

IdentifierTypeStateIssuer
007713400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PA9105117FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saltzman, Tanis, Pittel, Levin and Jacobson Past Accepting new patients
Saltzman, Tanis, Pittell, Levin and Jacobson Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: geneman-becker@pa.trimed.direct-ci.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1319068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1497030571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S PINE ISLAND RD",
            "address_2": "SUITE 800",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243920",
            "telephone_number": "305-940-6016",
            "fax_number": "305-940-6167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9611 W BROWARD BLVD",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242334",
            "telephone_number": "954-924-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4972 Town Center Pkwy",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322468595",
            "country_code": "US",
            "telephone_number": "904-642-6100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11260 Sullivan St",
            "address_purpose": "LOCATION",
            "city": "Riverview",
            "state": "FL",
            "postal_code": "335782140",
            "country_code": "US",
            "telephone_number": "813-689-7571",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1610 NE Miami Gardens Dr",
            "address_purpose": "LOCATION",
            "city": "North Miami Beach",
            "state": "FL",
            "postal_code": "331794900",
            "country_code": "US",
            "telephone_number": "305-940-6016",
            "fax_number": "305-940-6167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENEMAN-BECKER",
        "first_name": "GABRIELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-20",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9105117",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007713400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.