Individual provider Active NPI

Jennifer M Qadir, PA-C

  • Physician Assistant
  • Port St Lucie, FL
National Provider Identifier
1639470347
Registry record updated Aug 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9105613 Issued in FL
Practice address
2100 SE Hillmoor Dr Ste 101
Port St Lucie, FL 34952-8057
Phone
(561) 262-8785
NPI assigned
Nov 11, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9105613 FL Primary

Addresses

Primary practice location

2100 SE Hillmoor Dr Ste 101
Port St Lucie, FL 34952-8057

Mailing address

612 SE Flamingo Ave
Stuart, FL 34996-3249
Phone (561) 262-8785

Other practice location 1

444 W Fort St Fl 2
Boise, ID 83702-4535
Phone (208) 422-1018

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
I20110107001068 FL Practitioner - Physician Assistant 7719176569 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Care and Wellness PLLCGroup PAC ID 7618466749, 2 clinicians

Practice addresses (Care Compare)

2100 SE Hillmoor Dr
Suite 101
Port St Lucie, FL 34952-8057
Phone (561) 262-8785

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9105613FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Care and Wellness PLLC Physician Assistant CurrentSince Jun 12, 2025 Accepting new patients

Locations

2100 SE Hillmoor Dr
Ste 101
Port St Lucie, FL 34952
Phone (561) 262-8785

Organizations & group practices 1

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 2

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": "1289433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786579200000",
    "number": "1639470347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 SE FLAMINGO AVE",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349963249",
            "telephone_number": "561-262-8785",
            "fax_number": "800-878-3965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 SE HILLMOOR DR STE 101",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349528057",
            "telephone_number": "561-262-8785"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "444 W Fort St Fl 2",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837024535",
            "country_code": "US",
            "telephone_number": "208-422-1018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QADIR",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-11",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.