Carol Burzon Galicia, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10004703A Issued in IN

Practice address

3919 W Jefferson Blvd Ste 2
Fort Wayne, IN 46804-6811

Phone

(260) 436-7722

Fax

(260) 459-0012

NPI assigned

Jan 8, 2025

Last updated

Jan 8, 2025By the provider in NPPES

Sex

Female

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 IN

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jefferson Park Pediatrics P CGroup PAC ID 2961748991, 4 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jefferson Park Pediatrics P C

  • Pediatrics Physician
  • Fort Wayne, IN
  • NPI 1629263181
  Medicare reassignment Care Compare group
• Jefferson Pediatrics, PC

  • Family Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1134542855
  NPD (past)

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

{
    "created_epoch": "1736294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1609686112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3919 W JEFFERSON BLVD STE 2",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046811",
            "telephone_number": "260-436-7722",
            "fax_number": "260-459-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 W JEFFERSON BLVD STE 2",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046811",
            "telephone_number": "260-436-7722",
            "fax_number": "260-459-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALICIA",
        "first_name": "CAROL",
        "middle_name": "BURZON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-08",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10004703A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joyce Edna Gaines-Reese, MSW
• Jason T. Gaisford, PA-C
• Alexa Gaitan, RBT
• Manohar Gajjela, MD
• Logan Galbraith, PA-C
• Jeremy R. Gall, ATC
• Anisha Galla
• Daniel F Gallagher, MD
• Hallie Gallion
• Leslie Gallmeier

• Physician Assistant in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; 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.