Individual provider Active NPI

Melissa C Fontenot, PA

  • Physician Assistant
  • Tallahassee, FL
National Provider Identifier
1982777264
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9104437 Issued in FL
Practice address
3334 Capital Medical Blvd
400
Tallahassee, FL 32308-8405
Phone
(850) 877-8174
Fax
(844) 261-6839
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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 PA9104437 FL Primary

Addresses

Primary practice location

3334 Capital Medical Blvd
400
Tallahassee, FL 32308-8405

Mailing address

3334 Capital Medical Blvd. #400
Tallahassee, FL 32308-4470
Phone (850) 877-8174

Other identifiers 1

IdentifierTypeStateIssuer
024969200MedicaidFL

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
I20080429000810 FL Practitioner - Physician Assistant 1951403591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
76.5 of 100Reported as group
Quality
47.27
Promoting interoperability
99
Improvement activities
40
Cost
75.24

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
007188GAMDPediatric Rehabilitation Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tallahassee Orthopedic Clinic III PL CurrentSince Jun 1, 2011 Accepting new patients
Tallahassee Orthopedic Clinic III, P.L. CurrentSince Jun 1, 2011 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
The University of Texas Health Science Center at San Antonio Past Accepting new patients

Locations

2011 Harrison Ave
Panama City, FL 32405
Phone (850) 691-4188

803 W Main St
Perry, FL 32347
Phone (850) 584-7078

1401 Centerville Rd
Ste 300
Tallahassee, FL 32308
Phone (850) 877-5115

3334 Capital Medical Blvd
Ste 400
Tallahassee, FL 32308

3334 Capital Medical Blvd
Tallahassee, FL 32308
Phone (850) 210-1808

603 Wheat Ave
Ste 800
Bainbridge, GA 39819
Phone (229) 246-3608

603 Wheat Ave
Bainbridge, GA 39819
Phone (229) 246-1209

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1982777264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3334 CAPITAL MEDICAL BLVD. #400",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084470",
            "telephone_number": "850-877-8174",
            "fax_number": "844-261-6839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3334 CAPITAL MEDICAL BLVD",
            "address_2": "400",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323088405",
            "telephone_number": "850-877-8174",
            "fax_number": "844-261-6839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTENOT",
        "first_name": "MELISSA",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024969200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.