Eric F Stakebake, MPAS, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9112051 Issued in FL

Practice address

429 2ND St NW
Winter Haven, FL 33881-4168

Phone

(813) 321-1786

Fax

(813) 321-1787

NPI assigned

Jan 24, 2013

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 UT, FL2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Suncoast Skin SolutionsGroup PAC ID 7416018221, 102 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles (3 of 5)

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JJJGBA

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.

• Suncoast Skin Solutions

  • Dermatology Physician
  • Lutz, FL
  • NPI 1487827416

  FL

  Medicare reassignment Care Compare group
• Ogden Clinic PC

  • Family Medicine Physician
  • Ogden, UT
  • NPI 1578550083

  UT

  Medicare reassignment
• Neurology Headache Associates, LLC

  • Neurology Physician
  • Lakeland, FL
  • NPI 1104538255

  Neurology

  NPD (past) Authorized official
• Ogden Clinic Specialty Services LLC

  • Sports Medicine (Family Medicine) Physician
  • Ogden, UT
  • NPI 1114203668

  Dermatology

  NPD
• Douglas K Pierce MD PA

  • Procedural Dermatology Physician
  • Largo, FL
  • NPI 1053515379
  NPD (past)

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

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1619215738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18228 N US HIGHWAY 41",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335494400",
            "telephone_number": "813-321-1786",
            "fax_number": "813-321-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 2ND ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814168",
            "telephone_number": "813-321-1786",
            "fax_number": "813-321-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAKEBAKE",
        "first_name": "ERIC",
        "middle_name": "F",
        "name_prefix": "Mr.",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-24",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spring Lake Dental
• Spring Lake NC, LLC
• Spring Lake NC, LLC
• SS Polk IV Community HC LLC
• St. Luke Physician Partners PLLC
• Andrea Elaine Stallworth, APRN, FNP-C
• Lashelia Ann Stancil, RMFTI
• Joey Stancombe, PTA
• Alina Stanica, MD
• Laura Stanley, RN

• All providers in Winter Haven, FL
• Physician Assistant in Florida

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