Individual provider Active NPI

Ebonique Maeweathers, P.A.

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1861545014
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9100975 Issued in FL
Practice address
9500 Satellite Blvd
Orlando, FL 32837-8464
Phone
(407) 859-5656
Fax
(407) 859-2124
NPI assigned
Jan 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 PA9100975 FL Primary

Addresses

Primary practice location

9500 Satellite Blvd
Orlando, FL 32837-8464

Mailing address

1109 SW 10TH St
Ocala, FL 34474-2725
Phone (352) 629-3455

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
I20190125001491 FL Practitioner - Physician Assistant 4385981570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Current Care PAGroup PAC ID 9739260019, 545 clinicians

Practice addresses (Care Compare)

1036 Dunn Ave
Suite 10
Jacksonville, FL 32218-6364
Phone (904) 903-5520

12421 S Orange Blossom TRL
Orlando, FL 32837-6508
Phone (904) 791-6213

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9100975FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care PA CurrentSince Sep 17, 2018 Accepting new patients
American Current Care P.a. CurrentSince Sep 17, 2018 Accepting new patients
U.S. Healthworks Medical Group of Florida, Inc. Past Accepting new patients

Locations

1036 Dunn Ave
Ste 10
Jacksonville, FL 32218
Phone (904) 903-5520

7800 NW 25th St
Ste 4
Miami, FL 33122
Phone (305) 593-2174

1109 SW 10th St
Ocala, FL 34471
Phone (352) 629-3433

4455 Medical Center Way
West Palm Beach, FL 33407
Phone (561) 881-0066

5080 Spectrum Dr
Ste 1200W
Addison, TX 75001

Organizations & group practices 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861545014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 SW 10TH ST",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344742725",
            "telephone_number": "352-629-3455",
            "fax_number": "352-629-8642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 SATELLITE BLVD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328378464",
            "telephone_number": "407-859-5656",
            "fax_number": "407-859-2124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAEWEATHERS",
        "first_name": "EBONIQUE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9100975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.