Individual provider Active NPI

Kevin Alexander Perez, PA-C

  • Medical Physician Assistant
  • Port Charlotte, FL
National Provider Identifier
1578234571
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9114989 Issued in FL
Practice address
4130 Tamiami TRL Unit 202
Port Charlotte, FL 33952-9207
Phone
(941) 787-7111
Fax
(941) 764-0872
NPI assigned
Sep 21, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9114989 FL Primary

Addresses

Primary practice location

4130 Tamiami TRL Unit 202
Port Charlotte, FL 33952-9207

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

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
I20210928003511 FL Practitioner - Physician Assistant 8820495138 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

1065 Tamiami TRL N
Nokomis, FL 34275-2144
Phone (941) 477-2364

12995 S Cleveland Ave
Suite 184
Fort Myers, FL 33907-7703
Phone (239) 939-2201

13807 Tamiami TRL
North Port, FL 34287-2069
Phone (941) 257-1108

13813 Metro Pkwy
Fort Myers, FL 33912-4343
Phone (239) 936-1343

13815 Tamiami TRL
North Port, FL 34287-2069
Phone (941) 426-4900

13823 Tamiami TRL
North Port, FL 34287-2069
Phone (941) 888-0770

150 W McKenzie St
Punta Gorda, FL 33950-5500
Phone (941) 621-6476

19531 Cochran Blvd
Port Charlotte, FL 33948-2081
Phone (941) 255-3535

2675 Winkler Ave
Fort Myers, FL 33901-9328

2675 Winkler Avenue
Suite 200
Fort Myers, FL 33901-9328

4130 Tamiami TRL
Suite 2
Port Charlotte, FL 33952-9207
Phone (941) 787-7100

900 Pine St
Suite 221
Englewood, FL 34223-4458
Phone (941) 548-1708

Hospital & facility affiliations

  • Millennium Home Care LLC Home health agency, Port Charlotte, FL, CCN 109401

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC CurrentSince May 24, 2024 Accepting new patients
Millennium Physician Group LLC CurrentSince May 24, 2024 Accepting new patients

Locations

1708 Cape Coral Pkwy W
Ste 10
Cape Coral, FL 33914
Phone (239) 541-4633

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

4130 Tamiami Trl
Unit 202
Pt Charlotte, FL 33952
Phone (941) 629-1814

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: kevin.perez.1@4290.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 1

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": "1632182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1578234571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774",
            "fax_number": "239-599-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 TAMIAMI TRL UNIT 202",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339529207",
            "telephone_number": "941-787-7111",
            "fax_number": "941-764-0872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "KEVIN",
        "middle_name": "ALEXANDER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-21",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9114989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.