Individual provider Active NPI

Ann Louise Threatte, D.O.

  • Internal Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1174952469
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS13704 Issued in FL
Practice address
1839 Central Ave
St Petersburg, FL 33713-8900
Phone
(727) 322-1054
Fax
(727) 322-2725
NPI assigned
Nov 6, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS13704 FL Primary

Addresses

Primary practice location

1839 Central Ave
St Petersburg, FL 33713-8900

Mailing address

1839 Central Ave
St Petersburg, FL 33713
Phone (727) 322-1054

Other identifiers 2

IdentifierTypeStateIssuer
H0JX6OtherFLBLUE CROSS
112765400MedicaidFL

Other names 1

  • Ann Threatte Other name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160809001576 FL Practitioner - Internal Medicine 4082908348 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Professional Health Care of Pinellas, LLCGroup PAC ID 1658274675, 88 clinicians

Practice addresses (Care Compare)

1839 Central Ave
St Petersburg, FL 33713-9089
Phone (727) 322-1054

Merit-based Incentive Payment System (MIPS)

Final score
70.73 of 100Reported as group
Quality
8.6
Promoting interoperability
90
Improvement activities
40
Cost
68.84

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Health Care of Pinellas LLC Internal Medicine CurrentSince Aug 17, 2023 Accepting new patients
Professional Health Care of Pinellas Inc. CurrentSince Aug 17, 2023 Accepting new patients

Locations

6502 Park Blvd N
Pinellas Park, FL 33781
Phone (727) 541-5544

1839 Central Ave
St Petersburg, FL 33713
Phone (727) 322-1054

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIJHAA

Organizations & group practices 2

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": "1383696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1174952469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "33713",
            "telephone_number": "727-322-1054",
            "fax_number": "727-322-2725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337138900",
            "telephone_number": "727-322-1054",
            "fax_number": "727-322-2725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THREATTE",
        "first_name": "ANN",
        "middle_name": "LOUISE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-06",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS13704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "H0JX6",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112765400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANN",
            "last_name": "THREATTE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.