Karen Kelley Mathis, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9103274 Issued in FL

Practice address

1354 State Road 60 E
Lake Wales, FL 33853-4322

Phone

(863) 679-8888

Fax

(863) 676-2851

NPI assigned

Jul 6, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Karen Kay Mathis Other name

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

Locations

Interoperability endpoints

• Direct secure messaging: kmathis69559@direct.nemours.org

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.

• The Nemours Foundation

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1386658615
  Medicare reassignment
• The Nemours Foundation

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1265585806
  NPD
• The Nemours Foundation

  • Children's Hospital
  • Wilmington, DE
  • NPI 1467505073
  NPD

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362441600000",
    "number": "1679504492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1354 STATE ROAD 60 E",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534322",
            "telephone_number": "863-679-8888",
            "fax_number": "863-676-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1354 STATE ROAD 60 E",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534322",
            "telephone_number": "863-679-8888",
            "fax_number": "863-676-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "KAREN",
        "middle_name": "KELLEY",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2013-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9103274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1679504492",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292213400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAREN",
            "last_name": "MATHIS",
            "middle_name": "KAY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Maryam Bangash DDS Holdings PLLC
• Kara Kathleen Maschmeyer
• Ravi B Masih, M.D.
• Mithun Mathew
• Jeffrey Mathews
• Max Forni DMD P.a.
• Diane McCray-Brown, OTA/L
• Diane Michelle McCrummen, LMT
• Katherine McDonald, LMHC
• David Francis McDowall, D.D.S.

• Medical Physician Assistant in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2013; 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.