Individual provider Active NPI

Damon Florian Dicharry, PA

  • Physician Assistant
  • Bartow, FL
National Provider Identifier
1811275381
Registry record updated Aug 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA106087 Issued in FL
Practice address
2200 Osprey Blvd
Bartow, FL 33830-3308
Phone
(800) 893-9698
NPI assigned
Aug 1, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2011

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 PA106087 FL Primary

Addresses

Primary practice location

2200 Osprey Blvd
Bartow, FL 33830-3308

Mailing address

200 Corporate Blvd
Suite 201
Lafayette, LA 70508-3870
Phone (800) 893-9698

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
I20110930000551 FL Practitioner - Physician Assistant 1254503998 Reassigns benefits to 4 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
FL-I Medical Services, LLC Physician Assistant CurrentSince May 29, 2014 Accepting new patients
FL-I Medical Services LLC Physician Assistant CurrentSince May 29, 2014 Accepting new patients

Locations

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

1700 S 23rd St
Fort Pierce, FL 34950
Phone (772) 461-4000

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312156800000",
    "number": "1811275381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "address_2": "SUITE 201",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 OSPREY BLVD",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338303308",
            "telephone_number": "800-893-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICHARRY",
        "first_name": "DAMON",
        "middle_name": "FLORIAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-01",
        "last_updated": "2011-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA106087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartow, FL

Sources for this page

Verify at the official NPI Registry.