Individual provider Active NPI

Marykate H Vellis, PA-C

  • Medical Physician Assistant
  • Gainesville, FL
National Provider Identifier
1720060833
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA2618 Issued in FL
Practice address
6420 W Newberry Rd
East Wing, Suite 100
Gainesville, FL 32605-4308
Phone
(352) 332-3900
Fax
(352) 332-5009
NPI assigned
Nov 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA2618 FL Primary

Addresses

Primary practice location

6420 W Newberry Rd
East Wing, Suite 100
Gainesville, FL 32605-4308

Mailing address

PO Box 102222
Atlanta, GA 30368-2222
Phone (239) 274-8200

Other identifiers 1

IdentifierTypeStateIssuer
110832000MedicaidFL

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141021001780 FL Practitioner - Physician Assistant 1456572205 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6420 W Newberry Rd E Wing
1 Florida Cancer Specialists P L
Gainesville, FL 32605-4308
Phone (352) 332-3900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA2618FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Cancer Specialists & Research Institute, LLC CurrentSince Sep 3, 2014 Accepting new patients
Florida Cancer Specialists & Research Institute, LLC Past Accepting new patients
Robert R Carroll MD PA Past Accepting new patients

Locations

4371 Veronica S Shoemaker Blvd
Fort Myers, FL 33916
Phone (239) 432-8500

6420 W Newberry Rd
Ste 100
Gainesville, FL 32605
Phone (352) 332-3900

795 SW State Road 47
Lake City, FL 32025
Phone (386) 401-7066

1970 Golf St
Fl Cancer
Sarasota, FL 34236
Phone (941) 795-3780

460 N Orlando Ave
Ste 200
Winter Park, FL 32789
Phone (407) 898-5452

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783641600000",
    "number": "1720060833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102222",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682222",
            "telephone_number": "239-274-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6420 W NEWBERRY RD",
            "address_2": "EAST WING, SUITE 100",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054308",
            "telephone_number": "352-332-3900",
            "fax_number": "352-332-5009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELLIS",
        "first_name": "MARYKATE",
        "middle_name": "H",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-15",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA2618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110832000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.