Individual provider Active NPI

Danielle Marie Bakalar, PA

  • Physician Assistant
  • Fort Myers, FL
National Provider Identifier
1902142599
Registry record updated Nov 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9109626 Issued in FL
Practice address
2621 Cleveland Ave
Fort Myers, FL 33901-5802
Phone
(239) 425-1270
Fax
(239) 479-7708
NPI assigned
Dec 31, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2016

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 PA9109626 FL Primary

Addresses

Primary practice location

2621 Cleveland Ave
Fort Myers, FL 33901-5802

Mailing address

15051 S Tamiami TRL
Suite 203
Fort Myers, FL 33908-5182
Phone (239) 437-8810

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
I20170126002134 FL Practitioner - Physician Assistant 1557506714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
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)

1015 Crosspointe Dr
Naples, FL 34110-0949
Phone (239) 596-9075

3268 Forum Blvd
Suite 201
Fort Myers, FL 33905-5585
Phone (239) 232-1176

7331 Gladiolus Dr
Fort Myers, FL 33908-5101
Phone (239) 437-8810

9400 Gladiolus Dr
Suite 320
Fort Myers, FL 33908-9622
Phone (239) 482-7546

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Naples Center for Dermatology & Riverchase Dermatology CurrentSince Dec 1, 2016 Accepting new patients

Locations

413 Del Prado Blvd S
Ste 101
Cape Coral, FL 33990
Phone (239) 443-1500

3268 Forum Blvd
Ste 201
Fort Myers, FL 33905
Phone (239) 232-1176

7331 Gladiolus Dr
Fort Myers, FL 33908
Phone (239) 437-8810

15051 S Tamiami Trl
Ste 203
Fort Myers, FL 33908
Phone (239) 732-5959

2621 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 220-5561

1015 Crosspointe Dr
Naples, FL 34110
Phone (239) 596-9075

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: dbakalar@aquadermatology.emadirect.md

Organizations & group practices 2

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": "1356912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479859200000",
    "number": "1902142599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15051 S TAMIAMI TRL",
            "address_2": "SUITE 203",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339085182",
            "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": "2621 CLEVELAND AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339015802",
            "telephone_number": "239-425-1270",
            "fax_number": "239-479-7708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKALAR",
        "first_name": "DANIELLE",
        "middle_name": "MARIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-31",
        "last_updated": "2016-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.