Individual provider Active NPI

Christine Profito, PSY.D.

  • Psychologist
  • Bradenton, FL
National Provider Identifier
1346590486
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY8830 Issued in FL
Practice address
4835 27TH St W Ste 125
Bradenton, FL 34207-1759
Phone
(941) 753-0064
Fax
(941) 753-2977
NPI assigned
Sep 17, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY8830 FL Primary

Addresses

Primary practice location

4835 27TH St W Ste 125
Bradenton, FL 34207-1759

Mailing address

4835 27TH St W Ste 125
Bradenton, FL 34207-1759
Phone (941) 753-0064

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130917000551 FL Practitioner - Clinical Psychologist 8729222500 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Debra K Carter PH D and Associates PAGroup PAC ID 0547234379, 9 clinicians

Practice addresses (Care Compare)

4835 27TH St W
Suite 125
Bradenton, FL 34207-1759
Phone (941) 753-0064

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PY8830FLMDPsychologist

Practice roles (1 of 2)

OrganizationSpecialtyStatusNew patients
Debra K Carter PH D & Associates PA CurrentSince Sep 1, 2013 Accepting new patients

Locations

4835 27th St W
Ste 125
Bradenton, FL 34207
Phone (941) 753-0064

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: debrakcarterphd&associatespa.christineprofito@135184.advancedmd-direct.com

Organizations & group practices 1

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": "1347840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1346590486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4835 27TH ST W STE 125",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342071759",
            "telephone_number": "941-753-0064",
            "fax_number": "941-753-2977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4835 27TH ST W STE 125",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342071759",
            "telephone_number": "941-753-0064",
            "fax_number": "941-753-2977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROFITO",
        "first_name": "CHRISTINE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-17",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY8830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.