Colin Chan, M.D.
Individual provider Active NPI Family Medicine Physician · St Petersburg, FL
NPI 1194710871 · NPPES record last updated Mar 30, 2026
Key facts
- NPI
- 1194710871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- ME73079 (FL)
- Practice address
- 12450 Roosevelt Blvd N
Suite 101
St Petersburg, FL 33716-1902 - Phone
- (727) 571-1688
- Fax
- (727) 572-0900
- NPI assigned
- Sep 19, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- West Coast Primary Care LLC
Practice addresses (Care Compare)
12450 Roosevelt Blvd
Suite 101
Saint Petersburg, FL 33716-1902
12450 Roosevelt Blvd N
Suite 101
St Petersburg, FL 33716-1902
Phone (727) 571-1688
603 7TH St S
Suite 520
Saint Petersburg, FL 33701-4734
Phone (727) 322-4226
Hospital & facility affiliations
- St Josephs Hospital
- St Anthonys Hospital
- HCA Florida St Petersburg Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101028001326 | FL | Practitioner - Family Practice | 0749474278 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME73079 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orlando Health, Inc. | Current | Accepting new patients | |
| West Coast Primary Care, LLC | Family Medicine | Current |
Accepting new patients |
| Suncoast Medical Clinic LLC | Past | Accepting new patients | |
| Suncoast Medical Clinic LLC | Past | Accepting new patients | |
| Suncoast Medical Clinic LLC | Past | Accepting new patients |
Locations
12450 Roosevelt Blvd N
Ste 101
St Petersburg, FL 33716
Phone (727) 571-1688
601 7th St S
St Petersburg, FL 33701
Phone (727) 572-0900
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/HIGJBA/Endpoint/HIGJBA
- https://fhir4.healow.com/fhir/r4/HIGJBA
- cchan188753@orlandohealth.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME73079 | FL | Yes |
Addresses
Primary practice location
12450 Roosevelt Blvd N
Suite 101
St Petersburg, FL 33716-1902
Mailing address
12450 Roosevelt Blvd N Ste 101
St Petersburg, FL 33716-1902
Phone (727) 571-1688
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 252278100 | Medicaid | FL |
Other providers in St Petersburg, FL
- Robert Olin Chamberlin
- Colleen Chambers
- Jennifer Rebecca Chambers
- Wilfredo Chamizo
- Champion Comprehensive Virtual Services LLC
- Daniel Tim Chan
- Denise Michelle Chan
- Mark Chan
- Rainer Quijada Chan
- Sebrina Chan
All providers in St Petersburg, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.