Individual provider Active NPI

Joseph L Perry, PA-C

  • Physician Assistant
  • Melbourne, FL
National Provider Identifier
1952375776
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9109578 Issued in FL
Practice address
709 S Harbor City Blvd Ste 110
Melbourne, FL 32901-1938
Phone
(321) 499-4646
Fax
(321) 270-9449
NPI assigned
Feb 16, 2006
Last updated
Aug 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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 PA9109578 FL Primary

Addresses

Primary practice location

709 S Harbor City Blvd Ste 110
Melbourne, FL 32901-1938

Mailing address

709 S Harbor City Blvd Ste 110
Melbourne, FL 32901-1938
Phone (321) 499-4646

Other identifiers 1

IdentifierTypeStateIssuer
9SQWDOtherFLFLORIDA BLUE

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
I20161018001541 FL Practitioner - Physician Assistant 3375587769 Reassigns benefits to 3 organizations

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
Total Spine and WellnessGroup PAC ID 9931516804, 6 clinicians

Practice addresses (Care Compare)

709 S Harbor City Blvd
Suite 110
Melbourne, FL 32901-1906
Phone (321) 499-4646

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9109578FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince Apr 1, 2020 Accepting new patients
Steward Medical Group, Inc CurrentSince Apr 1, 2020 Accepting new patients
East Texas Medical Center Healthcare Associates Physician Assistant Past Accepting new patients
Stewart and Stewart a Medical Corporation Past Accepting new patients
Wesley Bradley Dosher PLLC PastSince Jun 15, 2021 Accepting new patients

Locations

8000 Ron Beatty Blvd
Ste A-3
Sebastian, FL 32976
Phone (772) 664-1388

Organizations & group practices 7

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 2

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": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1952375776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 S HARBOR CITY BLVD STE 110",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011938",
            "telephone_number": "321-499-4646",
            "fax_number": "321-270-9449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 S HARBOR CITY BLVD STE 110",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011938",
            "telephone_number": "321-499-4646",
            "fax_number": "321-270-9449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRY",
        "first_name": "JOSEPH",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-16",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "9SQWD",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.