Michael A Banuchi, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9102654 Issued in FL

Practice address

1295 Jacaranda Blvd.
Venice, FL 34292-4522

Phone

(941) 484-1510

Fax

(941) 484-1071

NPI assigned

Oct 17, 2006

Last updated

Jun 30, 2015By the provider in NPPES

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

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aqua Dermatology of Florida, PAGroup PAC ID 1153390414, 184 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: mbanuchi@aquadermatology.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aqua Dermatology of Florida, PA

  dba Gardens Plastic Surgery

  • Dermatology Physician
  • Palm Beach Gardens, FL
  • NPI 1538270335
  Medicare reassignment Care Compare group
• Naples Center for Dermatology & Riverchase Dermatology

  dba Riverchase Dermatology

  • Durable Medical Equipment & Medical Supplies
  • Cape Coral, FL
  • NPI 1538645775
  NPD
• Dermatology Consultants of S FL PA

  • Dermatology Physician
  • Coral Springs, FL
  • NPI 1629186523
  NPD (past)
• Skin and Cancer Associates

  • Dermatology Physician
  • Plantation, FL
  • NPI 1427017292
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435622400000",
    "number": "1851472187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15051 S. TAMIAMI TRAIL",
            "address_2": "SUITE 203",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33908",
            "telephone_number": "239-437-8810",
            "fax_number": "239-313-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1295 JACARANDA BLVD.",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924522",
            "telephone_number": "941-484-1510",
            "fax_number": "941-484-1071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANUCHI",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2015-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA9102654",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy J Baker, ARNP
• Dana Balatsos
• Josiah Bancroft, MD
• Laura Wasylenko Bancroft, M.D.
• Richard Banton, LCSW
• Terra Suzanne Barber, CRNA
• Ellen Barcan
• Barclay Pharmacy Inc (Barclay Pharmacy)
• Barclay Pharmacy Inc. (Barclay Pharmacy)
• Barclay's Apothecary Shoppe

• Physician Assistant in Venice, FL
• Providers in Venice, 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 30, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.