Individual provider Active NPI

Nikki-Ann Giliam McGovern, PA-C

  • Medical Physician Assistant
  • Orlando, FL
National Provider Identifier
1770672172
Registry record updated Sep 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9103180 Issued in FL
Practice address
2415 N Orange Ave Ste 302
Orlando, FL 32804-5505
Phone
(407) 303-7250
Fax
(407) 303-7255
NPI assigned
Oct 12, 2006
Last updated
Sep 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9103180 FL
Medical Physician Assistant 363AM0700X PA9103180 FL Primary

Addresses

Primary practice location

2415 N Orange Ave Ste 302
Orlando, FL 32804-5505

Mailing address

2415 N Orange Ave Ste 302
Orlando, FL 32804-5505
Phone (407) 303-7250

Other practice location 1

2501 N Orange Ave
Suite 402
Orlando, FL 32804-4603
Phone (407) 303-7250

Other names 1

  • Nikki Ann Giliam Former name

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
I20140414002085 FL Practitioner - Physician Assistant 7911139522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

2415 N Orange Ave
Orlando, FL 32804-5505

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Mar 17, 2014 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Mar 17, 2014 Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

900 Winderley Pl
Ste 1400
Maitland, FL 32751
Phone (407) 200-2700

2415 N Orange Ave
Ste 302
Orlando, FL 32804
Phone (407) 303-7250

2501 N Orange Ave
Ste 402
Orlando, FL 32804
Phone (407) 303-3638

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: nmcgovern73348@adventhealth.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1770672172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 N ORANGE AVE STE 302",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328045505",
            "telephone_number": "407-303-7250",
            "fax_number": "407-303-7255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 N ORANGE AVE STE 302",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328045505",
            "telephone_number": "407-303-7250",
            "fax_number": "407-303-7255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 N Orange Ave",
            "address_2": "Suite 402",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328044603",
            "country_code": "US",
            "telephone_number": "407-303-7250",
            "fax_number": "407-303-7255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCGOVERN",
        "first_name": "NIKKI-ANN",
        "middle_name": "GILIAM",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103180",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9103180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NIKKI",
            "last_name": "GILIAM",
            "middle_name": "ANN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.