Individual provider Active NPI

Cheryl Plotkin, PA

  • Medical Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1851388672
Registry record updated Jun 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA 2202 Issued in FL
Practice address
2 Shircliff Way
Suite 800
Jacksonville, FL 32204-4753
Phone
(904) 388-2619
Fax
(904) 388-0240
NPI assigned
Oct 6, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA 2202 FL Primary

Addresses

Primary practice location

2 Shircliff Way
Suite 800
Jacksonville, FL 32204-4753

Mailing address

7015 Ac Skinner Parkway
Suite 1
Jacksonville, FL 32256
Phone (904) 363-2113

Other identifiers 3

IdentifierTypeStateIssuer
290477200MedicaidFL
Y03PVOtherFLBC BS
7720498OtherFLAETNA

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
I20040901000749 FL Practitioner - Physician Assistant 1951376995 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA 2202FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cancer Specialists, LLC CurrentSince Oct 1, 2012 Accepting new patients
Cancer Specialists, LLC CurrentSince Oct 1, 2012 Accepting new patients
Integrated Community Oncology Network LLC Past Accepting new patients

Locations

1715 Eagle Harbor Pkwy
Ste C
Fleming Island, FL 32003
Phone (904) 264-6201

5742 Booth Rd
Ste A
Jacksonville, FL 32207
Phone (904) 739-7779

7015 A C Skinner Pkwy
Ste 1
Jacksonville, FL 32256
Phone (904) 363-2113

2 Shircliff Way
Ste 800
Jacksonville, FL 32204
Phone (904) 388-2619

600 Zeagler Dr
Ste 1
Palatka, FL 32177
Phone (386) 325-8140

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370563200000",
    "number": "1851388672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7015 AC SKINNER PARKWAY",
            "address_2": "SUITE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-363-2113",
            "fax_number": "904-538-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SHIRCLIFF WAY",
            "address_2": "SUITE 800",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044753",
            "telephone_number": "904-388-2619",
            "fax_number": "904-388-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLOTKIN",
        "first_name": "CHERYL",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-06",
        "last_updated": "2013-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA 2202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290477200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "Y03PV",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7720498",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.