Active NPI
Carlos A Agudelo, PA
- Physician Assistant
- Davie, FL
National Provider Identifier
1669845285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9109267
- Practice address
- 4111 Stirling Rd
Davie, FL 33314-7535 - Phone
- (954) 608-2220
- NPI assigned
- Nov 4, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9109267 | FL | Primary |
Addresses
Primary practice location
4111 Stirling Rd
Davie, FL 33314-7535
Mailing address
401 NW 42ND Ave
Plantation, FL 33317-2835
Phone (954) 608-2220
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160803000775 | FL | Practitioner - Physician Assistant | 9931493624 | Reassigns benefits to 4 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9109267 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| FL-I Medical Services LLC | Physician Assistant | Current | Accepting new patients |
| FL-I Medical Services, LLC | Physician Assistant | Current | Accepting new patients |
Locations
322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858
1700 S 23rd St
Fort Pierce, FL 34950
Phone (772) 461-4000
20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290
401 NW 42nd Ave
Plantation, FL 33317
Phone (954) 513-6434
Interoperability endpoints
- carlos.agudelo.1@25843.direct.athenahealth.com
Organizations & group practices 6
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.
-
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- Haines City, FL
- NPI 1285356790
-
- Emergency Medicine Physician
- Gainesville, FL
- NPI 1871155887
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481587200000",
"number": "1669845285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 NW 42ND AVE",
"city": "PLANTATION",
"state": "FL",
"postal_code": "333172835",
"telephone_number": "954-608-2220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4111 STIRLING RD",
"city": "DAVIE",
"state": "FL",
"postal_code": "333147535",
"telephone_number": "954-608-2220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGUDELO",
"first_name": "CARLOS",
"middle_name": "A",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-04",
"last_updated": "2016-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9109267",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; 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.