Individual provider Active NPI

Robin Carr

  • Physician Assistant
  • Palm Coast, FL
National Provider Identifier
1780341669
Registry record updated Nov 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9115329 Issued in FL
Practice address
264 Palm Coast Pkwy NE
Palm Coast, FL 32137-8217
Phone
(386) 446-5505
NPI assigned
Nov 26, 2021
Last updated
Nov 26, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2021

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 PA9115329 FL Primary

Addresses

Primary practice location

264 Palm Coast Pkwy NE
Palm Coast, FL 32137-8217

Mailing address

801 Bugle Branch Way
Saint Johns, FL 32259-4449
Phone (904) 614-6075

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
I20211203001240 FL Practitioner - Physician Assistant 3577953660 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Island Doctors Intrastate LLCGroup PAC ID 5395161186, 74 clinicians

Practice addresses (Care Compare)

100 Arricola Ave
Saint Augustine, FL 32080-4515
Phone (904) 825-4368

2460 Old Moultrie Rd
St Augustine, FL 32086-4198

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lina L Feaster PA PastSince Jan 2, 2004 Accepting new patients

Organizations & group practices 3

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 6

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": "1637884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637884800000",
    "number": "1780341669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 BUGLE BRANCH WAY",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322594449",
            "telephone_number": "904-614-6075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 PALM COAST PKWY NE",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378217",
            "telephone_number": "386-446-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARR",
        "first_name": "ROBIN",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-26",
        "last_updated": "2021-11-26",
        "certification_date": "2021-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9115329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

Verify at the official NPI Registry.