Individual provider Active NPI

Carl Leonidas Loveridge, PA-C

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1881636272
Registry record updated Aug 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9104074 Issued in FL
Practice address
601 E Rollins St
Orlando, FL 32803
Phone
(407) 303-7283
Fax
(407) 303-0347
NPI assigned
Jun 12, 2006
Last updated
Aug 23, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2018

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 PA9104074 FL Primary

Addresses

Primary practice location

601 E Rollins St
Orlando, FL 32803

Mailing address

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 303-7283

Other identifiers 1

IdentifierTypeStateIssuer
292583400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070502000415 FL Practitioner - Physician Assistant 6204867625 Reassigns benefits to 2 organizations
I20200522001289 GA Practitioner - Physician Assistant 6204867625 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9104074FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Phoebe Dorminy Kids Health CurrentSince Jul 1, 2020 Accepting new patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Aug 20, 2018 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Aug 20, 2018 Accepting new patients
Phoebe Physician Group, Inc CurrentSince Jul 1, 2020 Accepting new patients
Northwest Emergency Physicians LLC Past Accepting new patients

Locations

900 Hope Way
Forest City, FL 32714
Phone (407) 357-1255

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

3100 E Fletcher Ave
#C
Tampa, FL 33613

2002 Palmyra Rd
Ste 201
Albany, GA 31701
Phone (229) 312-5802

500 W 3rd Ave
Ste 101
Albany, GA 31701
Phone (229) 312-5802

151 Mayo St
Ste B
Americus, GA 31709
Phone (229) 928-2900

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: cloveridge616867@adventhealth.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534982400000",
    "number": "1881636272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E ROLLINS ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031248",
            "telephone_number": "407-303-7283",
            "fax_number": "407-303-0347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E ROLLINS ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32803",
            "telephone_number": "407-303-7283",
            "fax_number": "407-303-0347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOVERIDGE",
        "first_name": "CARL",
        "middle_name": "LEONIDAS",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2018-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292583400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.