Samuel Gordon Hathcock, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9116218 Issued in FL

Practice address

410 Celebration PL Ste 300
Celebration, FL 34747-5434

Phone

(407) 894-4474

Fax

(407) 894-7032

NPI assigned

Jun 28, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: shathcock2153273@adventhealth.direct-ci.com

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.

• Florida Hospital Medical Group Inc

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1225034234

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Interventional Cardiologists of Gainesville, PA

  • Interventional Cardiology Physician
  • Gainesville, FL
  • NPI 1811931629
  Medicare reassignment
• Florida Hospital Medical Group Inc

  • Prosthetic/Orthotic Supplier
  • Minneola, FL
  • NPI 1285591545
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Adventist Health System-Sunbelt, Inc

  • General Acute Care Hospital
  • Orlando, FL
  • NPI 1306938071
  Care Compare affiliation
• Adventist Health System-Sunbelt, Inc

  • Clinical Medical Laboratory
  • Orlando, FL
  • NPI 1801569728

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1992375554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 NW 8TH AVE",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054687",
            "telephone_number": "352-375-1212",
            "fax_number": "352-371-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 CELEBRATION PL STE 300",
            "city": "CELEBRATION",
            "state": "FL",
            "postal_code": "347475434",
            "telephone_number": "407-894-4474",
            "fax_number": "407-894-7032"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4645 NW 8th Ave",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326054687",
            "country_code": "US",
            "telephone_number": "352-375-1212",
            "fax_number": "352-371-4650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HATHCOCK",
        "first_name": "SAMUEL",
        "middle_name": "GORDON",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-28",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110-008149",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA BOARD OF MEDICINE LICENSE",
            "identifier": "0110-008149",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Alex Harrington, DMD
• Brenda Lucille Harris-Watson, MD
• Blaire Harter, M.A.,C.C.C.
• Farah Mahbub Hartmann, M.D.
• Robert Jonathan Hassan, MD
• Daniel Hawkins, PHARMD
• Maham Hayat, MD
• Marcos S Hazday, MD
• Heart Clinic of Central Florida LLC
• Laura Beth Hedetniemi, PHARM.D.

• Physician Assistant in Celebration, FL
• Providers in Celebration, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.