Individual provider Active NPI

Kendall Cory Marhalik, PA-C

  • Physician Assistant
  • Clermont, FL
National Provider Identifier
1760736912
Registry record updated Mar 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1900 Don Wickham Dr
Clermont, FL 34711-1979
Phone
(352) 241-7180
Fax
(352) 241-7184
NPI assigned
Nov 8, 2012
Last updated
Mar 19, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2020

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 Primary

Addresses

Primary practice location

1900 Don Wickham Dr
Clermont, FL 34711-1979

Mailing address

913 Easley Ave
Winter Garden, FL 34787-5387
Phone (407) 497-9485

Other practice location 1

2001 S Main St
Suite 200
Wake Forest, NC 27587-1649
Phone (919) 562-3155

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
I20160629001427 FL Practitioner - Physician Assistant 8527211986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.2 of 100Reported as group
Quality
78.64
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Organizations & group practices 1

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": "1352332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1760736912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 EASLEY AVE",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347875387",
            "telephone_number": "407-497-9485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 DON WICKHAM DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111979",
            "telephone_number": "352-241-7180",
            "fax_number": "352-241-7184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 S Main St",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Wake Forest",
            "state": "NC",
            "postal_code": "275871649",
            "country_code": "US",
            "telephone_number": "919-562-3155",
            "fax_number": "919-550-0735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARHALIK",
        "first_name": "KENDALL",
        "middle_name": "CORY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-08",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

Verify at the official NPI Registry.