ADVANCED SURGICAL & PHYSICIAN ASSISTANT SERVICES INC — NPI 1053043059 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical in INDIALANTIC, FL)

CMS-1500 Box 24J / 33a • NPI

1053043059

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

363AS0400X (CMS 97)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical

Box 32 Service Location & ZIP+4

461 MALLARD LN, INDIALANTIC, FL, 32903-4735

✓ 9-Digit EDI 837 ZIP+4 (32903-4735)

Practice Phone & Referral Fax

(407) 451-0192

Fax: (321) 600-4004

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1053043059 (ADVANCED SURGICAL & PHYSICIAN ASSISTANT SERVICES INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1053043059` (NPI-2 Organization / Facility)
Provider / Legal Name	ADVANCED SURGICAL & PHYSICIAN ASSISTANT SERVICES INC
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical NUCC Code: `363AS0400X` (Physician Assistant, Surgical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	461 MALLARD LN, INDIALANTIC, FL, 32903-4735
Practice Telephone / Fax	Tel: (407) 451-0192 \| Fax: (321) 600-4004
Administrative Mailing Address	PO BOX 410185, MELBOURNE, FL, 32941-0185
Enumeration & Last Sync	Enumerated: 2022-06-28 \| CMS Record Updated: 2022-06-28
Authorized Official	DALE GREYSLAK (OWNER)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

461 MALLARD LN, INDIALANTIC, FL, 32903-4735

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Plain-English Taxonomy & CMS Crosswalk (363AS0400X)

What Does Taxonomy Code 363AS0400X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363AS0400X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant, Surgical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADVANCED SURGICAL & PHYSICIAN ASSISTANT SERVICES INC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363AS0400X` — Physician Assistant, Surgical Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ADVANCED SURGICAL & PHYSICIAN ASSISTANT SERVICES INC (NPI #1053043059)