Individual provider Active NPI

Kacie June Brewer, PA

  • Surgical Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1639506199
Registry record updated Nov 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9107527 Issued in FL
Practice address
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone
(904) 953-2000
NPI assigned
Sep 30, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 0110005142 VA
Surgical Physician Assistant 363AS0400X PA9107527 FL Primary

Addresses

Primary practice location

4500 San Pablo Rd S
Jacksonville, FL 32224-1865

Mailing address

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000

Other practice location 1

800 Prudential Dr Ste 1100
Jacksonville, FL 32207
Phone (904) 388-6518

Other identifiers 3

IdentifierTypeStateIssuer
003140599BMedicaidGA
003140599AMedicaidGA
009664700MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kbrewer1799850@ehrdirect.mayoclinicmsg.org

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
I20131004000442 FL Practitioner - Physician Assistant 0840424818 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mayo Clinic JacksonvilleGroup PAC ID 5698689297, 1,595 clinicians

Practice addresses (Care Compare)

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9107527FLMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Jacksonville CurrentSince Aug 29, 2022 Accepting new patients
Mayo Clinic Jacksonville CurrentSince Aug 29, 2022 Accepting new patients
Florida Institute of Pain Medicine LLC CurrentSince Feb 22, 2025 Accepting new patients
University of Florida Jacksonville Physicians Inc CurrentSince Dec 19, 2016 Accepting new patients
Florida Institute of Pain Medicine LLC CurrentSince Feb 22, 2025 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Dec 19, 2016 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Jun 9, 2021 Accepting new patients

Locations

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000

800 Prudential Dr
Ste 1100
Jacksonville, FL 32207
Phone (904) 338-6518

800 Prudential Dr
Fl B11
Jacksonville, FL 32207

4500 San Pablo Rd S
Jacksonville, FL 32224
Phone (904) 721-4815

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

105 Whitehall Dr
Ste 115
St Augustine, FL 32086
Phone (904) 800-7246

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Organizations & group practices 9

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": "1380499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669075200000",
    "number": "1639506199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 SAN PABLO RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241865",
            "telephone_number": "904-953-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 SAN PABLO RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241865",
            "telephone_number": "904-953-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Prudential Dr Ste 1100",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "32207",
            "country_code": "US",
            "telephone_number": "904-388-6518",
            "fax_number": "904-384-1005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BREWER",
        "first_name": "KACIE",
        "middle_name": "JUNE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-30",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "0110005142",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9107527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003140599B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003140599A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009664700",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbrewer1799850@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "4500 San Pablo Rd S",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322241865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.