Elizabeth Mathew Pullukala, is a medicare enrolled "Hospitalist" in Jacksonville, Florida. She graduated from nursing school in 2022 and has 4 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Vip Specialties Of Florida, First Coast Surgical Associates Inc. and her current practice location is
2098 Knottingham Trace Ln, Jacksonville, Florida. You can reach out to her office (for appointments etc.) via phone at
(904) 525-3684.
Elizabeth Mathew Pullukala is licensed to practice in Florida (license number APRN11025870) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1174305742.
Provider's Profile
| Full Name | Elizabeth Mathew Pullukala |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 4 Years |
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| Location | 2098 Knottingham Trace Ln, Jacksonville, Florida |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Elizabeth Mathew Pullukala graduated from nursing school in 2022
NPI Data:
- NPI Number: 1174305742
- Provider Enumeration Date: 10/18/2023
- Last Update Date: 04/16/2026
Medicare PECOS Information:
- PECOS PAC ID: 4082158613
- Enrollment ID: I20240706000328
Medical Identifiers
Medical identifiers for Elizabeth Mathew Pullukala such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1174305742 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363L00000X | Nurse Practitioner | 11025870 (Florida) | Secondary |
| 208M00000X | Hospitalist | APRN11025870 (Florida) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Vip Specialties Of Florida | 7810355708 | 25 |
| First Coast Surgical Associates Inc. | 5395779359 | 30 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Elizabeth Mathew Pullukala allows following entities to bill medicare on her behalf.
| Entity Name | First Coast Surgical Associates Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1548249543
PECOS PAC ID: 5395779359
Enrollment ID: O20070109000450 |
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| Entity Name | San Jose Clinic, P.a. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1083846349
PECOS PAC ID: 3577606664
Enrollment ID: O20100212000030 |
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| Entity Name | Vip Specialties Of Florida |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1790499812
PECOS PAC ID: 7810355708
Enrollment ID: O20230626001309 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Elizabeth Mathew Pullukala is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Elizabeth Mathew Pullukala,
2098 Knottingham Trace Ln,
Jacksonville, FL 32246-1396
Ph: (904) 525-3684 | Elizabeth Mathew Pullukala,
2098 Knottingham Trace Ln,
Jacksonville, FL 32246-1396
Ph: (904) 525-3684 |
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