Individual provider Active NPI

Stacy Mathew, PA-C

  • Physician Assistant
  • Miami Shores, FL
National Provider Identifier
1720882137
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9119928 Issued in FL
Practice address
11300 NE 2ND Ave
Miami Shores, FL 33161-6628
Phone
(305) 899-3000
NPI assigned
Apr 3, 2025
Last updated
Apr 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9119928 FL Primary

Addresses

Primary practice location

11300 NE 2ND Ave
Miami Shores, FL 33161-6628

Mailing address

11300 NE 2ND Ave
Miami Shores, FL 33161-6628
Phone (305) 899-3000

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
I20250510000152 FL Practitioner - Physician Assistant 0446777601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11406 US Hwy 301 S
TGH Urgent Care Powered by Fast Tra
Riverview, FL 33578-6170
Phone (813) 925-1903

16521 S US Hwy 301
TGH Urgent Care Powered by Fast Tra
Wimauma, FL 33598-2032
Phone (813) 928-1903

5464 Lithia Pinecrest Rd
Lithia, FL 33547-2853
Phone (813) 925-1903

799 W Lumsden Rd
TGH Urgent Care Powered by Fast Tra
Brandon, FL 33511-6261
Phone (813) 925-1903

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9119928FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Synergic Healthcare Solutions LLC CurrentSince May 6, 2025 Accepting new patients
Synergic Healthcare Solutions LLC CurrentSince May 6, 2025 Accepting new patients
Synergic Healthcare Solutions LLC Current Accepting new patients

Locations

5504 Gateway Blvd
Wesley Chapel, FL 33544
Phone (813) 948-5400

16521 US 301 S
Wimauma, FL 33598
Phone (813) 844-4700

200 N Bryant Ave
Ste 10
Edmond, OK 73034

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1743638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1720882137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11300 NE 2ND AVE",
            "city": "MIAMI SHORES",
            "state": "FL",
            "postal_code": "331616628",
            "telephone_number": "305-899-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11300 NE 2ND AVE",
            "city": "MIAMI SHORES",
            "state": "FL",
            "postal_code": "331616628",
            "telephone_number": "305-899-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "STACY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-03",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9119928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami Shores, FL

Sources for this page

Verify at the official NPI Registry.