Individual provider Active NPI

Haley Lane Beuttell

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1508647330
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9118024 Issued in FL
Practice address
10475 Centurion Pkwy N Ste 303
Jacksonville, FL 32256-5004
Phone
(904) 399-0350
NPI assigned
Oct 9, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 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 9118024 FL
Physician Assistant 363A00000X 9118024 FL Primary

Addresses

Primary practice location

10475 Centurion Pkwy N Ste 303
Jacksonville, FL 32256-5004

Mailing address

10475 Centurion Pkwy N Ste 303
Jacksonville, FL 32256-5004

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
I20231113001595 FL Practitioner - Physician Assistant 2365899317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Florida Surgeons PAGroup PAC ID 2769381391, 336 clinicians

Practice addresses (Care Compare)

10475 Centurion Pkwy N
Suite 303
Jacksonville, FL 32256-5004
Phone (904) 399-0350

Hospital & facility affiliations

  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Baptist Medical Center Beaches Hospital, Jacksonville Beach, FL, CCN 100117
  • Southeast Georgia Health System -- Camden Campus Hospital, Saint Marys, GA, CCN 110146
  • Baptist Medical Center - Nassau Hospital, Fernandina Beach, FL, CCN 100140
  • Brooks Rehabilitation Hospital University Campus Inpatient rehabilitation facility, Jacksonville, FL, CCN 103039

Merit-based Incentive Payment System (MIPS)

Final score
81.79 of 100Reported as group
Quality
64.42
Promoting interoperability
100
Improvement activities
40
Cost
74.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9118024FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Florida Surgeons, PA CurrentSince Oct 23, 2023 Accepting new patients
North Florida Surgeons, PA CurrentSince Oct 23, 2023 Accepting new patients

Locations

11945 San Jose Blvd
Ste 300
Jacksonville, FL 32223

10475 Centurion Pkwy N
Ste 303
Jacksonville, FL 32256
Phone (904) 399-0350

11945 San Jose Blvd
Ste 102
Jacksonville, FL 32223
Phone (904) 268-3937

Interoperability endpoints

  • Direct secure messaging: haley.beuttell.1@9109.direct.athenahealth.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.

Hospital & facility affiliations 6

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": "1696809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1508647330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10475 CENTURION PKWY N STE 303",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10475 CENTURION PKWY N STE 303",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565004",
            "telephone_number": "904-399-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEUTTELL",
        "first_name": "HALEY",
        "middle_name": "LANE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9118024",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9118024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.