Individual provider Active NPI

Jennifer Kay Hiecke, PA-C

  • Medical Physician Assistant
  • St Petersburg, FL
National Provider Identifier
1083611735
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9102321 Issued in FL
Practice address
1201 5TH Ave N
Suite 202
St Petersburg, FL 33705-1400
Phone
(727) 820-7701
Fax
(727) 820-7700
NPI assigned
Jul 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9102321 FL Primary

Addresses

Primary practice location

1201 5TH Ave N
Suite 202
St Petersburg, FL 33705-1400

Mailing address

1201 5TH Ave N Ste 202
St Petersburg, FL 33705-1410
Phone (727) 820-7701

Other identifiers 2

IdentifierTypeStateIssuer
P00733266OtherFLRAILROAD MEDICARE PROVIDER NUMBER
106274100MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jennifer.hiecke@direct.mybaycare.org Health Information Exchange (HIE) BayCare Medical Group, Inc.

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
I20070402000322 FL Practitioner - Physician Assistant 0042314072 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baycare Medical Group, Inc.Group PAC ID 6406753623, 1,539 clinicians

Practice addresses (Care Compare)

1200 7TH Ave N
St Petersburg, FL 33705-1300
Phone (727) 820-7737

2461 Enterprise Rd
Suite C
Clearwater, FL 33763-1726
Phone (727) 725-5060

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Medical Group, Inc. CurrentSince Sep 1, 2015 Accepting new patients
Baycare Medical Group Pediatric Walk-in Care LLC Past Accepting new patients
Baycare Medical Group Pediatric Walk-in, LLC Past Accepting new patients
Baycare Medical Group, Inc. Physician Assistant Past Accepting new patients
The Eye Physicians of Pinellas, PA Past Accepting new patients
St. Anthony'S Specialists LLC Past Accepting new patients

Locations

2995 Drew St
Fl 2
Clearwater, FL 33759
Phone (727) 315-7234

2461 Enterprise Rd
Ste C
Clearwater, FL 33763
Phone (727) 725-5060

2995 Drew St
Bldg 2ND
Clearwater, FL 33759

603 7th St S
Ste 540
St Petersburg, FL 33701
Phone (727) 553-7550

900 Carillon Pkwy
Ste 303
St Petersburg, FL 33716
Phone (727) 556-0363

1201 5th Ave N
Ste 202
St Petersburg, FL 33705
Phone (727) 820-7701

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1083611735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 5TH AVE N STE 202",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051410",
            "telephone_number": "727-820-7701",
            "fax_number": "727-820-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 5TH AVE N",
            "address_2": "SUITE 202",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051400",
            "telephone_number": "727-820-7701",
            "fax_number": "727-820-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIECKE",
        "first_name": "JENNIFER",
        "middle_name": "KAY",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9102321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PROVIDER NUMBER",
            "identifier": "P00733266",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106274100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jennifer.hiecke@direct.mybaycare.org",
            "affiliation": "Y",
            "affiliationName": "BayCare Medical Group, Inc.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2995 Drew Street",
            "address_2": "East Bldg 2nd Floor",
            "city": "Clearwater",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.