Jimmy Allen Wyatt, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9103344 Issued in FL

Practice address

350 N Clyde Morris Blvd
Daytona Beach, FL 32114-2733

Phone

(386) 238-3289

Fax

(386) 238-3296

NPI assigned

Sep 29, 2005

Last updated

Apr 19, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CCSG, IncGroup PAC ID 6103130745, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Archbold Memorial Hospital Hospital, Thomasville, GA, CCN 110038

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jimmy.wyatt@hca5.eclinicaldirectplus.com
• Direct secure messaging: jimmywyatt@tmhpp.allscriptsdirect.net

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.

• CCSG, Inc.

  • Cardiovascular Disease Physician
  • Thomasville, GA
  • NPI 1295120145
  Medicare reassignment Care Compare group
• Florida Health Care Plan, Inc

  dba FHCP ASC - Orange City

  • Ambulatory Surgical Clinic/Center
  • Orange City, FL
  • NPI 1659759827
  NPD (past)

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

• John D Archbold Memorial Hospital Inc

  dba Archbold Memorial

  • General Acute Care Hospital
  • Thomasville, GA
  • NPI 1194779702
  Care Compare affiliation
• John D. Archbold Memorial Hospital, Inc.

  dba John D. Archbold Memorial Hospital - Rehab

  • Rehabilitation Hospital Unit
  • Thomasville, GA
  • NPI 1104867738
  Care Compare affiliation

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492560000000",
    "number": "1578550257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 NEEDLE PALM DR",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321323322",
            "telephone_number": "386-424-0158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142733",
            "telephone_number": "386-238-3289",
            "fax_number": "386-238-3296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "JIMMY",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2017-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9103344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Pierre Wright, R.N.
• Dean C Wright, CRNA
• Vincent D Wright, CRNA
• Wulff Medical Inc
• Kristin L Wulff, MD
• Sharniece Wyatt
• Alik Wyche
• Laurence T Wylie
• Cheryl J Wynn, DPT
• Julianne M Wysocki Broadwater, D.O.

• Medical Physician Assistant in Daytona Beach, FL
• Providers in Daytona Beach, 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 Apr 19, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.