NPIMap

Individual provider Active NPI

Ashley Dawn Pack, FNP-BC

  • Family Nurse Practitioner
  • Bradenton, FL
National Provider Identifier
1508104050
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11019355 Issued in FL
Practice address
2318 Manatee Ave W
Bradenton, FL 34205-5432
Phone
(941) 714-7150
Fax
(941) 845-4963
NPI assigned
Jan 17, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 70977 WV
Family Nurse Practitioner 363LF0000X APRN11019355 FL Primary

Addresses

Primary practice location

2318 Manatee Ave W
Bradenton, FL 34205-5432

Mailing address

101 Riverfront Blvd Ste 710
Bradenton, FL 34205-8812
Phone (941) 776-4000

Other practice location 1

1207 Hospital Dr
Hurricane, WV 25526-8707
Phone (304) 757-4151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130403000330 WV Practitioner - Nurse Practitioner 2365687886 Reassigns benefits to 1 organization
I20220707001024 FL Practitioner - Nurse Practitioner 2365687886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Area Medical Center IncGroup PAC ID 3375441637, 969 clinicians

Practice addresses (Care Compare)

800 Pennsylvania Ave
Charleston, WV 25302-3351
Phone (304) 388-5432

Hospital & facility affiliations

  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11019355FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MCR Health, Inc. Family CurrentSince Jun 29, 2022 Accepting new patients
MCR Health, Inc. CurrentSince Jun 29, 2022 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Jun 13, 2024 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Jun 13, 2024 Accepting new patients
Femcare PLLC PastSince Sep 1, 2012 Accepting new patients
Womens Health Center of West Virginia Inc PastSince Jul 4, 2010 Accepting new patients

Locations

2318 Manatee Ave W
Bradenton, FL 34205
Phone (941) 714-7150

101 Riverfront Blvd
Ste 710
Bradenton, FL 34205

12271 US Highway 301 N
Parrish, FL 34219
Phone (941) 713-2231

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

800 Pennsylvania Ave
Charleston, WV 25302
Phone (304) 388-2550

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26000/brand/2/csg/1/fhir/r4

Organizations & group practices 6

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1358380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1508104050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 RIVERFRONT BLVD STE 710",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342058812",
            "telephone_number": "941-776-4000",
            "fax_number": "941-845-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2318 MANATEE AVE W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342055432",
            "telephone_number": "941-714-7150",
            "fax_number": "941-845-4963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1207 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Hurricane",
            "state": "WV",
            "postal_code": "255268707",
            "country_code": "US",
            "telephone_number": "304-757-4151",
            "fax_number": "304-757-4813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACK",
        "first_name": "ASHLEY",
        "middle_name": "DAWN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-17",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "70977",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11019355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.