Phillip Alex Wimpelberg, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9101929 Issued in FL

Practice address

2720 US Highway 1 S
Ste B
St Augustine, FL 32086-6301

Phone

(904) 827-0078

Fax

(904) 827-0140

NPI assigned

Oct 2, 2006

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 2

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, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ibrahim Heart Clinic PLLCGroup PAC ID 4688958648, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Flagler Hospital Hospital, Saint Augustine, FL, CCN 100090
• Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
• Mayo Clinic Hospital, Jacksonville, FL, CCN 100151

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Ibrahim Heart Clinic PLLC

  • Clinical Cardiac Electrophysiology Physician
  • Jacksonville, FL
  • NPI 1629511035
  Medicare reassignment Care Compare group
• Primecare PL

  • Cardiovascular Disease Physician
  • St Augustine, FL
  • NPI 1407038169
  Medicare reassignment
• Robert C Kelsey MD PA

  • Cardiovascular Disease Physician
  • St Augustine, FL
  • NPI 1982798740
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Flagler Hospital Inc

  • General Acute Care Hospital
  • St Augustine, FL
  • NPI 1144211020
  Care Compare affiliation
• Flagler Hospital, Inc.

  • Urgent Care Clinic/Center
  • Saint Augustine, FL
  • NPI 1447527965

  Hospital

  Care Compare affiliation
• Mayo Clinic Florida

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1891782470
  Care Compare affiliation
• Southern Baptist Hospital of Florida Inc

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1578620449
  Care Compare affiliation

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359590400000",
    "number": "1871686352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 US HIGHWAY 1 S",
            "address_2": "STE B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866301",
            "telephone_number": "904-827-0078",
            "fax_number": "904-827-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 US HIGHWAY 1 S",
            "address_2": "STE B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866301",
            "telephone_number": "904-827-0078",
            "fax_number": "904-827-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMPELBERG",
        "first_name": "PHILLIP",
        "middle_name": "ALEX",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2013-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9101929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291914100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00295658",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Kate Wilson, MD
• Rebecca Wilson
• Terrence James Wilson, MD, MPH
• Uliana Wilson
• Brooke Alison Wimberley, DNP, FNP-BC
• Jon Windom, DDS
• Wings of Hope Therapy Center LLC
• Wings of Hope Therapy Center LLC
• Nicole Winkels, APRN
• Janet Wiseman, LMHC

• Medical Physician Assistant in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; 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.