Alfred Otero, PA-C, MPAS

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 0003636 Issued in FL

Practice address

1465 W US Highway 90 Ste 100
Lake City, FL 32055-6154

Phone

(386) 755-2268

Fax

(386) 243-8448

NPI assigned

Apr 16, 2007

Sex

Male

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

Physician Assistant

State licenses

Practice roles

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.

• Baya Urgent Care LLC

  • Urgent Care Clinic/Center
  • Lake City, FL
  • NPI 1447688619
  Medicare reassignment
• Southern Internal Medicine PLLC

  • Internal Medicine Physician
  • Lake City, FL
  • NPI 1912188624
  Medicare reassignment
• Nes of Florida Inc

  • Emergency Medicine Physician
  • Gainesville, FL
  • NPI 1063407070
  NPD (past)
• Nes of Florida Inc

  • Emergency Medicine Physician
  • Ocala, FL
  • NPI 1598707689
  NPD (past)
• Nes of Northern Florida Inc

  • Emergency Medicine Physician
  • Gainesville, FL
  • NPI 1558583161
  NPD (past)

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591920000000",
    "number": "1801011663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 SW PACES GLN",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "32024",
            "telephone_number": "352-672-0184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 W US HIGHWAY 90 STE 100",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320556154",
            "telephone_number": "386-755-2268",
            "fax_number": "386-243-8448"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "404 NW Hall Of Fame Dr",
            "address_purpose": "LOCATION",
            "city": "Lake City",
            "state": "FL",
            "postal_code": "320554833",
            "country_code": "US",
            "telephone_number": "386-719-2540",
            "fax_number": "386-752-9073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTERO",
        "first_name": "ALFRED",
        "name_prefix": "Mr.",
        "credential": "PA-C, MPAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 0003636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291002100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miguel Angel Ortiz
• Osprey of North Florida, Inc.
• Donna Frances Osteen
• Taylor N Ostendorf
• Carly Ostrom, PH.D.
• Jonathan Christian Overson, DMD
• Dakeriyah S Owens-Dortly
• Elaine L Owens, LCSW
• Julie Lynn Owens, OD
• Samantha Lynn Owens

• Physician Assistant in Lake City, FL
• Providers in Lake City, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; 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.