Kenneth Edward Nida, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 9107756 Issued in FL

Practice address

320 N Clyde Morris Blvd
Daytona Beach, FL 32114-2744

Phone

(386) 238-3293

Fax

(386) 238-3223

NPI assigned

Nov 4, 2008

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

Other identifiers 3

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

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.

• Florida Health Care Plan, Inc

  dba FHCP ASC - Orange City

  • Ambulatory Surgical Clinic/Center
  • Orange City, FL
  • NPI 1659759827
  NPD (past)
• Our Lady of the Lake Hospital Inc

  dba Lake Primary Care Physicians

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1275577603
  NPD (past)

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

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433721600000",
    "number": "1659525681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9671",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321209671",
            "telephone_number": "386-676-7130",
            "fax_number": "386-676-7125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142744",
            "telephone_number": "386-238-3293",
            "fax_number": "386-238-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIDA",
        "first_name": "KENNETH",
        "middle_name": "EDWARD",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-04",
        "last_updated": "2015-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 9107756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y0Q8M",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014260400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1659525681",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Nguyen, DO
• Huong Thien Nguyen, DMD
• Ly Nguyen, DMD
• Timothy Allen Nicastro Jr., DNP
• Elizabeth Paige Nicks, LMHC
• Michele Niedermeyer, APRN
• Caitlin Nies, LMT
• Hector D. Nieves-Vazquez, M.D.
• Andrew Jonathan Niewald, MD
• Neil Baker Nipper, M.D.

• Physician Assistant in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.