Bobby John Ardila, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9102779 Issued in FL

Practice address

410 Celebration PL
Suite 200
Celebration, FL 34747-5433

Phone

(407) 303-4673

Fax

(407) 303-4674

NPI assigned

Apr 4, 2006

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Evolution Health & Performance LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Daytona Beach, FL
  • NPI 1376161380
  NPD Authorized official

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240185600000",
    "number": "1699737783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 CELEBRATION PL",
            "address_2": "SUITE 200",
            "city": "CELEBRATION",
            "state": "FL",
            "postal_code": "347475433",
            "telephone_number": "407-303-4673",
            "fax_number": "407-303-4674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 CELEBRATION PL",
            "address_2": "SUITE 200",
            "city": "CELEBRATION",
            "state": "FL",
            "postal_code": "347475433",
            "telephone_number": "407-303-4673",
            "fax_number": "407-303-4674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARDILA",
        "first_name": "BOBBY",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2009-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9102779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291863300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Phillip Richard Anderson III, M.D.
• John Andrich, PA-C
• Kevin Apel, DC
• Casiana Rose Aponte, PA-C
• Rachael Suzanne Arabian, PT
• Paula Andrea Ardila, PA-C
• Mary Ellen Ashton, LMT
• Assessability, LLC
• At Home With US LLC
• James Sutlive Atkins Jr., MD

• Surgical Physician Assistant in Celebration, FL
• Providers in Celebration, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.