Kevin Douglas Lille, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9101308 Issued in FL

Practice address

21298 Olean Blvd
Fawcett Memorial Hospital
Port Charlotte, FL 33952

Phone

(941) 627-6130

Fax

(941) 627-6146

NPI assigned

Jul 29, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

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

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spinal Health and Rehab of Punta GordaGroup PAC ID 7214053727, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Spinal Health and Rehab of Punta Gorda

  • Sports Medicine (Internal Medicine) Physician
  • Punta Gorda, FL
  • NPI 1184946691
  Medicare reassignment Care Compare group NPD
• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  Medicare reassignment
• FL-I Medical Services, LLC

  • Nurse Practitioner
  • Fort Pierce, FL
  • NPI 1750655106
  Medicare reassignment
• Florida Hospital Physician Group Inc

  dba AdventHealth Medical Group

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1174955256
  Medicare reassignment
• Ies Florida PLLC

  • Emergency Medicine Physician
  • Venice, FL
  • NPI 1124788716
  Medicare reassignment
• Physicians for Quality Healthcare, Inc.

  dba Physicians Rehabilitation

  • Physical Medicine & Rehabilitation Physician
  • Fort Myers, FL
  • NPI 1528353554
  Medicare reassignment
• Southwest Florida Emergency Physicians, PA

  • Emergency Medicine Physician
  • Fort Myers, FL
  • NPI 1588659502
  Medicare reassignment
• Wellness by Physicians, Inc.

  dba Physicians Rehabilitation

  • Physical Medicine & Rehabilitation Physician
  • Fort Myers, FL
  • NPI 1821459322
  Medicare reassignment
• FL - I Medical Services LLC

  • Nurse Practitioner
  • Aventura, FL
  • NPI 1275808701

  Physician Assistant

  NPD
• FL-I Medical Services LLC

  • Physician Assistant
  • Haines City, FL
  • NPI 1285356790
  NPD
• Wellness by Physicians, Inc.

  dba Physicians Rehabilitation

  • Physical Medicine & Rehabilitation Physician
  • Lady Lake, FL
  • NPI 1518488907
  NPD
• Emcare Physician Providers, Inc.

  • Emergency Medicine Physician
  • Punta Gorda, FL
  • NPI 1376592063
  NPD (past)

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679588750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3141 NW 63RD",
            "address_2": "SUITE 4",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73116",
            "telephone_number": "405-607-1318",
            "fax_number": "405-607-1326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21298 OLEAN BLVD",
            "address_2": "FAWCETT MEMORIAL HOSPITAL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "33952",
            "telephone_number": "941-627-6130",
            "fax_number": "941-627-6146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLE",
        "first_name": "KEVIN",
        "middle_name": "DOUGLAS",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lifeline Home Health Care of Port Charlotte, LLC (Lifeline Health Care of Port Charlotte)
• Lifestyle Hearing Aid Center, LC
• Lifeworks Substance Abuse Services LLC
• Cameron Maria Light, LM CPM
• Lighthouse Addiction Services
• Peter Lin, MD
• Lincare Inc. (Patients First)
• Allison Taylor Lindsey
• Elizabeth Mary Lindsey
• Kimberly S Lindstrom, ARNP

• Physician Assistant in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.