Katherine Marie Eberly, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9104814 Issued in FL

Practice address

12469 Emerald Coast Pkwy W
Suite 101
Miramar Beach, FL 32550-8305

Phone

(850) 654-3376

Fax

(850) 654-3320

NPI assigned

Jul 23, 2007

Sex

Female

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

Other names 1

• Katherine Marie James Former name

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

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.

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  • NPI 1114238193
  Medicare reassignment
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  • Internal Medicine Physician
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  • NPI 1962666974
  Medicare reassignment

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

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424217600000",
    "number": "1801096268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12469 EMERALD COAST PKWY W",
            "address_2": "SUITE 101",
            "city": "MIRAMAR BEACH",
            "state": "FL",
            "postal_code": "325508305",
            "telephone_number": "850-654-3376",
            "fax_number": "850-654-3320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12469 EMERALD COAST PKWY W",
            "address_2": "SUITE 101",
            "city": "MIRAMAR BEACH",
            "state": "FL",
            "postal_code": "325508305",
            "telephone_number": "850-654-3376",
            "fax_number": "850-654-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERLY",
        "first_name": "KATHERINE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-23",
        "last_updated": "2015-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF FL",
            "identifier": "Y05LX",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "JAMES",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katie Dougherty
• Hannah Rose Duplantis, APRN
• Natalie A Dyer, RBT
• Destiny Eash
• Ashlee Charlena Eaton
• Eleanor Zimmerman, Psy.D., PLLC
• Emerald Coast Medical Management PLLC
• Emerald Coast Memory Clinic, LLC
• Emerald Coast Non-Emergency Transport LLC
• Noelle J Emmons, APRN

• Physician Assistant in Miramar Beach, FL
• Providers in Miramar Beach, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2015; 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.