Christopher Jacob Bordelon, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2018024459 Issued in MO

Practice address

2550 W Dr Martin Luther King Jr Blvd Ste B
Tampa, FL 33607-6302

Phone

(813) 876-6483

NPI assigned

Jul 10, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Observation Medical Group LLC

  • Emergency Medicine Physician
  • Tampa, FL
  • NPI 1952763682
  Medicare reassignment NPD
• Emergency Medical Associates of Tampa Bay, LLC

  • Emergency Medicine Physician
  • Tampa, FL
  • NPI 1023397817
  Medicare reassignment
• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650
  Medicare reassignment
• W4P LLC

  • Emergency Medicine Physician
  • Spring Hill, FL
  • NPI 1689116618
  NPD (past)

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

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1548756893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10414 NIGHTENGALE DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335694125",
            "telephone_number": "813-789-0565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 W DR MARTIN LUTHER KING JR BLVD STE B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076302",
            "telephone_number": "813-876-6483"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "946 E Reed St",
            "address_purpose": "LOCATION",
            "city": "Hayti",
            "state": "MO",
            "postal_code": "638511243",
            "country_code": "US",
            "telephone_number": "573-359-1372",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "304 Teaco Rd",
            "address_purpose": "LOCATION",
            "city": "Kennett",
            "state": "MO",
            "postal_code": "638573266",
            "country_code": "US",
            "telephone_number": "573-888-8828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORDELON",
        "first_name": "CHRISTOPHER",
        "middle_name": "JACOB",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-10",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9111443",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2018024459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101257900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Bootz, PA-C
• Srinivas S Boppana, D.O.
• Robert Carl Borchard Jr.
• Whitney Borchardt
• Stephen Michael Borchik, ATC
• Rachel Ann Ehrlich Bordelon, DO
• Mark Antonio Borden, M.D.
• Sarah N Borders
• Katie Borek
• Mattrhew James Borek Sr.

• Medical Physician Assistant in Tampa, FL
• Providers in Tampa, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.