Individual provider Active NPI

Kristy Lynn Chatham, PAC

  • Physician Assistant
  • Ocala, FL
National Provider Identifier
1942294269
Registry record updated Nov 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9102875 Issued in FL
Practice address
9401 SW Highway 200 Ste 1001
Ocala, FL 34481-9613
Phone
(813) 321-1786
Fax
(813) 321-1787
NPI assigned
Sep 1, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2022

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 PA9102875 FL Primary

Addresses

Primary practice location

9401 SW Highway 200 Ste 1001
Ocala, FL 34481-9613

Mailing address

4651 Van Dyke Rd
Lutz, FL 33558-4880
Phone (813) 321-1786

Other identifiers 2

IdentifierTypeStateIssuer
P00251111OtherFLSRRGA
292415300MedicaidFL

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
I20041206000698 FL Practitioner - Physician Assistant 8224094826

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9102875FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Douglas K Pierce MD PA PastSince Nov 13, 2022 Accepting new patients

Organizations & group practices 1

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": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668211200000",
    "number": "1942294269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4651 VAN DYKE RD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335584880",
            "telephone_number": "813-321-1786",
            "fax_number": "813-321-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9401 SW HIGHWAY 200 STE 1001",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344819613",
            "telephone_number": "813-321-1786",
            "fax_number": "813-321-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHATHAM",
        "first_name": "KRISTY",
        "middle_name": "LYNN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-01",
        "last_updated": "2022-11-12",
        "certification_date": "2022-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SRRGA",
            "identifier": "P00251111",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292415300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocala, FL

Sources for this page

Verify at the official NPI Registry.