Individual provider Active NPI

Shirley J Hom, PA C

  • Medical Physician Assistant
  • Orlando, FL
National Provider Identifier
1972598860
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9102291 Issued in FL
Practice address
1400 S Orange Ave
Orlando, FL 32806-2134
Phone
(321) 843-8010
Fax
(321) 843-6330
NPI assigned
Sep 16, 2005
Last updated
Jul 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9102291 FL
Surgical Physician Assistant 363AS0400X PA9102291 FL
Medical Physician Assistant 363AM0700X PA9102291 FL Primary

Addresses

Primary practice location

1400 S Orange Ave
Orlando, FL 32806-2134

Mailing address

1400 S Orange Ave
Orlando, FL 32806-2134
Phone (321) 843-8010

Other practice location 1

4215 Edgewater Dr
Orlando, FL 32804-2206
Phone (407) 539-2000

Other practice location 2

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 609-0095

Other identifiers 2

IdentifierTypeStateIssuer
E8990GOtherFLMEDICARE GROUP PTAN
291475100MedicaidFL

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
I20101021000973 FL Practitioner - Physician Assistant 4981597705 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

22 W Underwood St
Orlando, FL 32806-1110
Phone (407) 648-3800

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

32 W Gore St
Orlando, FL 32806-1134

380 Rinehart Rd
Lake Mary, FL 32746-2551
Phone (407) 767-1200

52 W Underwood St
Orlando, FL 32806-1110
Phone (407) 841-5111

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 303-2570

76 W Underwood St
Orlando, FL 32806-1110

86 W Underwood St
Orlando, FL 32806-1110
Phone (407) 896-1100

9400 Turkey Lake Rd
Orlando, FL 32819-8001
Phone (407) 354-1202

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13480CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Jun 18, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Jun 10, 2024 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Jun 18, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Jun 10, 2024 Accepting new patients
Southeastern Clinical Services,Inc. Surgical PastSince Jun 5, 2012 Accepting new patients
Stephen Schreiber, MD Past Accepting new patients

Locations

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

1400 S Orange Ave
Orlando, FL 32806
Phone (321) 841-1893

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

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

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: shom130562@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": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1972598860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062134",
            "telephone_number": "321-843-8010",
            "fax_number": "321-843-6330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062134",
            "telephone_number": "321-843-8010",
            "fax_number": "321-843-6330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4215 Edgewater Dr",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328042206",
            "country_code": "US",
            "telephone_number": "407-539-2000",
            "fax_number": "407-398-0050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 E Rollins St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328031248",
            "country_code": "US",
            "telephone_number": "407-609-0095",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOM",
        "first_name": "SHIRLEY",
        "middle_name": "J",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-16",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102291",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9102291",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9102291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "E8990G",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291475100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.