Individual provider Active NPI

Charles David Eldridge IV, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Saint Petersburg, FL
National Provider Identifier
1295912764
Registry record updated Jun 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
ME126811 Issued in FL
Practice address
501 6TH Ave S
Saint Petersburg, FL 33701-4634
Phone
(727) 767-8480
Fax
(727) 767-8420
NPI assigned
Jan 28, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 2009010647 MO
Pediatrics Physician 208000000X 2009010647 MO
Pediatrics Physician 208000000X ME126811 FL
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X ME126811 FL Primary

Addresses

Primary practice location

501 6TH Ave S
Saint Petersburg, FL 33701-4634

Mailing address

501 6TH Ave S
Saint Petersburg, FL 33701-4634
Phone (727) 767-8480

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
I20181107002748 FL Practitioner - Emergency Medicine 7416104849 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Inphynet Contracting Services LLC Pediatric Emergency Medicine CurrentSince Oct 1, 2020 Accepting new patients
Florida Em-I Medical Services PA Past Accepting new patients

Locations

951 N Washington Ave
Titusville, FL 32796
Phone (302) 325-5511

1 Tampa General Cir
University of Tampa, FL 33606
Phone (813) 251-5822

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466985600000",
    "number": "1295912764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337014634",
            "telephone_number": "727-767-8480",
            "fax_number": "727-767-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337014634",
            "telephone_number": "727-767-8480",
            "fax_number": "727-767-8420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELDRIDGE",
        "first_name": "CHARLES",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-28",
        "last_updated": "2016-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "MO",
            "license": "2009010647",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2009010647",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME126811",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "FL",
            "license": "ME126811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Petersburg, FL

Sources for this page

Verify at the official NPI Registry.