NPIMap

Individual provider Active NPI

Archana Pudur, M.D.

  • Family Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1235397688
Registry record updated Mar 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME102749 Issued in FL
Practice address
3745 33Rd St N
St Petersburg, FL 33713-1506
Phone
(727) 525-0006
Fax
(727) 521-3694
NPI assigned
Jun 1, 2008
Last updated
Mar 9, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME102749 FL Primary

Addresses

Primary practice location

3745 33Rd St N
St Petersburg, FL 33713-1506

Mailing address

PO Box 1830
Clearwater, FL 33757-1830
Phone (727) 532-0002

Other identifiers 2

IdentifierTypeStateIssuer
001163700MedicaidFL
P00791386OtherFLRAILROAD MEDICARE PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090724000712 FL Practitioner - Family Practice 9638222581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
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)

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

3745 33Rd St N
St Petersburg, FL 33713-1506
Phone (727) 525-0006

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Medical Group, Inc. Family Medicine CurrentSince Sep 1, 2015 Accepting new patients
Baycare Medical Group, Inc. Family Medicine CurrentSince Sep 1, 2015 Accepting new patients
St Anthony's Primary Care LLC Past Accepting new patients

Locations

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

1201 5th Ave N
Ste 408
St Petersburg, FL 33705
Phone (727) 894-3733

3745 33rd St N
St Petersburg, FL 33713
Phone (727) 231-0154

Interoperability endpoints

  • Direct secure messaging: archana.pudur@direct.mybaycare.org
  • FHIR API: https://fhir-myrecord.cerner.com/r4/00f37c04-43c3-4ddc-ac68-d7a0479d717b/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1212278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268092800000",
    "number": "1235397688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1830",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337571830",
            "telephone_number": "727-532-0002",
            "fax_number": "727-532-1318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3745 33RD ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337131506",
            "telephone_number": "727-525-0006",
            "fax_number": "727-521-3694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUDUR",
        "first_name": "ARCHANA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-01",
        "last_updated": "2010-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME102749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001163700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PROVIDER NUMBER",
            "identifier": "P00791386",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.