NPIMap

Individual provider Active NPI

Elias M. Kolettis, D.O.

  • Internal Medicine Physician
  • Clearwater, FL
National Provider Identifier
1346245891
Registry record updated Apr 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS7623 Issued in FL
Practice address
701 N Hercules Ave
Ste B
Clearwater, FL 33765-2029
Phone
(727) 738-8410
Fax
(727) 734-6254
NPI assigned
Jun 20, 2005
Last updated
Apr 12, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2016

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 OS7623 FL Primary

Addresses

Primary practice location

701 N Hercules Ave
Ste B
Clearwater, FL 33765-2029

Mailing address

701 N Hercules Ave
Ste B
Clearwater, FL 33765-2029
Phone (727) 738-8410

Other identifiers 2

IdentifierTypeStateIssuer
255469100MedicaidFL
46556OtherFLBCBS

Other names 1

  • Kolettis Krew LLC Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Ohio University, College of Osteopathic Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

701 N Hercules Ave
Suite B
Clearwater, FL 33765-2029

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Healthcare Options, Inc. PastSince Nov 24, 2019 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kolettiskrew@tkkl-fl.direct.office.nextgen.com

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 6

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": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460419200000",
    "number": "1346245891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N HERCULES AVE",
            "address_2": "STE B",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337652029",
            "telephone_number": "727-738-8410",
            "fax_number": "727-734-6254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N HERCULES AVE",
            "address_2": "STE B",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337652029",
            "telephone_number": "727-738-8410",
            "fax_number": "727-734-6254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLETTIS",
        "first_name": "ELIAS",
        "middle_name": "M.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS7623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255469100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "46556",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KOLETTIS KREW",
            "last_name": "LLC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.