Individual provider Active NPI

Michael Nguyen, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1497171565
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9107834 Issued in FL
Practice address
9826 San Jose Blvd
Jacksonville, FL 32257-5438
Phone
(904) 262-9444
Fax
(904) 262-3750
NPI assigned
Mar 12, 2014
Last updated
Mar 14, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9107834 FL Primary

Addresses

Primary practice location

9826 San Jose Blvd
Jacksonville, FL 32257-5438

Mailing address

8335 Freedom Crossing TRL Apt 2506
Jacksonville, FL 32256-1202
Phone (405) 819-3774

Other identifiers 1

IdentifierTypeStateIssuer
015824300MedicaidFL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20141118000711 FL Practitioner - Physician Assistant 5496977951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc CurrentSince Jul 25, 2016 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Jul 25, 2016 Accepting new patients
Physicians Medical Center, Inc. Past Accepting new patients

Locations

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

Interoperability endpoints

  • Direct secure messaging: mnguyen218697@direct.shands.ufl.edu

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1394582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489449600000",
    "number": "1497171565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8335 FREEDOM CROSSING TRL APT 2506",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561202",
            "telephone_number": "405-819-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9826 SAN JOSE BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575438",
            "telephone_number": "904-262-9444",
            "fax_number": "904-262-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-12",
        "last_updated": "2017-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9107834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015824300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.