Individual provider Active NPI

Tabitha Castrillon, PA-C

  • Physician Assistant
  • Daytona Beach, FL
National Provider Identifier
1770129413
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112512 Issued in FL
Practice address
1865 Lpga Blvd
Daytona Beach, FL 32117-7108
Phone
(386) 255-4596
Fax
(386) 258-3561
NPI assigned
Nov 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9112512 FL
Surgical Physician Assistant 363AS0400X PA9112512
Physician Assistant 363A00000X PA9112512 FL Primary

Addresses

Primary practice location

1865 Lpga Blvd
Daytona Beach, FL 32117-7108

Mailing address

1865 Lpga Blvd
Daytona Beach, FL 32117-7108
Phone (386) 255-4596

Other practice location 1

5535 S Williamson Blvd Ste 722
Port Orange, FL 32128-8311
Phone (386) 210-9862

Other practice location 2

600 Palmetto St
New Smyrna, FL 32168-7327
Phone (386) 210-9862

Other practice location 3

1075 Mason Ave
Daytona Beach, FL 32117-4611
Phone (386) 255-4596

Other identifiers 1

IdentifierTypeStateIssuer
104925100MedicaidFL

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
I20200103000934 FL Practitioner - Physician Assistant 7517391303 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians

Practice addresses (Care Compare)

1175 Dunlawton Ave
Suite 1
Port Orange, FL 32127-4741
Phone (386) 255-4596

1200 Lexington Green LN
Sanford, FL 32771-1013

1865 Lpga Blvd
Daytona Beach, FL 32117-7108
Phone (386) 255-4596

1890 Lpga Blvd
Suite 240
Daytona Beach, FL 32117-7131
Phone (386) 255-4596

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9112512FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Clinic of Daytona Beach PA CurrentSince Jun 5, 2023 Accepting new patients
Orthopaedic Clinic of Daytona Beach PA CurrentSince Jun 5, 2023 Accepting new patients

Locations

1865 Lpga Blvd
Daytona Beach, FL 32117
Phone (386) 255-4596

1075 Mason Ave
Daytona Beach, FL 32117
Phone (386) 255-4596

1890 Lpga Blvd
Ste 240
Daytona Beach, FL 32117
Phone (386) 255-4596

17 Old Kings Rd N
Ste K
Palm Coast, FL 32137
Phone (386) 255-4596

1165 Dunlawton Ave
Ste 102
Port Orange, FL 32127
Phone (386) 255-4596

1175 Dunlawton Ave
Ste 1
Port Orange, FL 32127
Phone (386) 255-4596

Interoperability endpoints

  • Direct secure messaging: tabitha.castrillon.1@10735.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/10735/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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 4

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": "1574035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1770129413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1865 LPGA BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177108",
            "telephone_number": "386-255-4596",
            "fax_number": "386-258-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1865 LPGA BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177108",
            "telephone_number": "386-255-4596",
            "fax_number": "386-258-3561"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5535 S Williamson Blvd Ste 722",
            "address_purpose": "LOCATION",
            "city": "Port Orange",
            "state": "FL",
            "postal_code": "321288311",
            "country_code": "US",
            "telephone_number": "386-210-9862",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Palmetto St",
            "address_purpose": "LOCATION",
            "city": "New Smyrna",
            "state": "FL",
            "postal_code": "321687327",
            "country_code": "US",
            "telephone_number": "386-210-9862",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1075 Mason Ave",
            "address_purpose": "LOCATION",
            "city": "Daytona Beach",
            "state": "FL",
            "postal_code": "321174611",
            "country_code": "US",
            "telephone_number": "386-255-4596",
            "fax_number": "386-258-3561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASTRILLON",
        "first_name": "TABITHA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-18",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9112512",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": "PA9112512",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104925100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.