Individual provider Active NPI

Patrick Edward Tolan III, PA-C

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1962985416
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9111562 Issued in FL
Practice address
9368 Narcoossee Rd Ste 104
Orlando, FL 32827-5704
Phone
(866) 400-3376
Fax
(407) 650-3455
NPI assigned
Sep 11, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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 PA9111562 FL Primary

Addresses

Primary practice location

9368 Narcoossee Rd Ste 104
Orlando, FL 32827-5704

Mailing address

151 Southhall LN Ste 300
Maitland, FL 32751-7172
Phone (866) 400-3376

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
I20190118001594 FL Practitioner - Physician Assistant 8921344508 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1410 W Broadway St
Suite 205
Oviedo, FL 32765-6472
Phone (407) 359-2100

9368 Narcoossee Rd
Suite 104
Orlando, FL 32827-5704
Phone (407) 745-1966

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9111562FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Leavitt Medical Associates of Florida Inc CurrentSince Aug 1, 2020 Accepting new patients
Leavitt Medical Associates of Florida Inc CurrentSince Aug 1, 2020 Accepting new patients
Leavitt Medical Associates of Florida Inc Past Accepting new patients
Shawnee Mission Medical Center Inc Past Accepting new patients

Locations

151 Southhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 917-7293

9368 Narcoossee Rd
Ste 104
Orlando, FL 32827
Phone (407) 745-1966

2868 S Alafaya Trl
Ste 130
Orlando, FL 32828
Phone (407) 770-0063

1410 W Broadway St
Ste 205
Oviedo, FL 32765
Phone (407) 359-2100

1503 Buenos Aires Blvd
Ste 100
The Villages, FL 32159
Phone (352) 753-2812

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: patrick.tolan@adcs1.emadirect.md

Organizations & group practices 4

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": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1962985416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172",
            "telephone_number": "866-400-3376",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9368 NARCOOSSEE RD STE 104",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328275704",
            "telephone_number": "866-400-3376",
            "fax_number": "407-650-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLAN",
        "first_name": "PATRICK",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-11",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.