Kelly Osullivan-Stobbe, PAC MS

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA0003199 Issued in FL

Practice address

202 N Park Ave
Apopka, FL 32703-4148

Phone

(407) 889-4711

Fax

(407) 889-7742

NPI assigned

Nov 4, 2005

Last updated

Sep 3, 2021By the provider in NPPES

Sex

Female

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

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

Master of Science, Physician Assistant

State licenses

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.

• Optumcare Florida LLC

  dba Optum

  • General Practice Physician
  • Tampa, FL
  • NPI 1053384214
  Medicare reassignment NPD
• Optumcare Florida, LLC

  dba Optum

  • Hospitalist Physician
  • Tampa, FL
  • NPI 1659884294
  NPD
• Seminole Primary Care Physicians PA

  • Family Medicine Physician
  • Longwood, FL
  • NPI 1386785202
  NPD (past)

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1750372934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 N PARK AVE",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327034148",
            "telephone_number": "407-889-4711",
            "fax_number": "407-889-7742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 N PARK AVE",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327034148",
            "telephone_number": "407-889-4711",
            "fax_number": "407-889-7742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSULLIVAN-STOBBE",
        "first_name": "KELLY",
        "credential": "PAC MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-04",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA0003199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "K9529",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jesus Ortiz-Morales, DC
• Salina Ashley Ortiz
• Shannon M Osorio, PA-C
• Carlos Humberto Ospina, D.C.
• Daniela Ostrowski, PTA
• Franza Joy Otero, LPN
• Dora Catherine Ottati, APRN
• Wendy Rene Ottati
• Our Family Health Inc.
• Ownorth, PLLC

• Physician Assistant in Apopka, FL
• Providers in Apopka, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; 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.