Makynzie Noel Bass, PA-C
Individual provider Active NPI Physician Assistant · Graceville, FL
NPI 1821620816 · NPPES record last updated Sep 18, 2024
Key facts
- NPI
- 1821620816
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA9113000 (FL)
- Practice address
- 5429 College Dr
Graceville, FL 32440-1858 - Phone
- (850) 263-0639
- NPI assigned
- Feb 7, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northwest Florida Healthcare, Inc.
Practice addresses (Care Compare)
1360 Brickyard Rd
Chipley, FL 32428-6303
Phone (850) 638-1610
1410 Brickyard Rd
Chipley, FL 32428-5966
Phone (850) 638-3400
5429 College Dr
Graceville, FL 32440-1858
Phone (850) 263-0639
925 Carlisle Rd
Chipley, FL 32428-4360
Phone (850) 638-9399
Hospital & facility affiliations
- Northwest Florida Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200317000100 | FL | Practitioner - Physician Assistant | 6002244647 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA911300 | FL | MD | Physician Assistant |
| PA9113000 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Department of Health | Current |
Accepting new patients | |
| Northwest Florida Healthcare, Inc | Current |
Accepting new patients | |
| Florida Department of Health | Current |
Accepting new patients | |
| Northwest Florida Healthcare, Inc | Current |
Accepting new patients | |
| Florida Department of Health | Past | Accepting new patients | |
| Walton County Health Department | Past | Accepting new patients | |
| Rural Primary Care South-Walton, Inc. | Past |
Accepting new patients |
Locations
101 E Wisconsin Ave
Bonifay, FL 32425
Phone (850) 547-2209
1376 Brickyard Rd
Ste 3
Chipley, FL 32428
Phone (850) 638-0552
1360 Brickyard Rd
Chipley, FL 32428
Phone (850) 415-8300
362 State Highway 83
Defuniak Springs, FL 32433
Phone (850) 892-8015
5429 College Dr
Graceville, FL 32440
Phone (850) 263-0639
Interoperability endpoints
- makynzie.o.bryan.1@14612.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9113000 | FL | Yes |
| Physician Assistant | 363A00000X | PA911300 | FL |
Addresses
Primary practice location
5429 College Dr
Graceville, FL 32440-1858
Mailing address
PO Box 889
Chipley, FL 32428-0889
Other names
- Mrs. Makynzie Noel O'Bryan
Other providers in Graceville, FL
- 2 Hearts 1 Love, LLC
- Tiffany Beech
- Jordan Christopher Bellamy
- Andrea L Braswell
- John Byrd
- Campbellton-Graceville Hospital
All providers in Graceville, FL · Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.