Individual provider Active NPI

Jennifer Arenas Davis, PA

  • Surgical Physician Assistant
  • St Petersburg, FL
National Provider Identifier
1356391973
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9102922 Issued in FL
Practice address
601 5TH St S
St Petersburg, FL 33701-4804
Phone
(727) 767-6666
NPI assigned
May 12, 2006
Last updated
Aug 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA2201 KY
Surgical Physician Assistant 363AS0400X PA9102922 FL Primary

Addresses

Primary practice location

601 5TH St S
St Petersburg, FL 33701-4804

Mailing address

601 5TH St S
St Petersburg, FL 33701-4804
Phone (727) 767-6666

Other practice location 1

3001 W Dr Martin Luther King Jr Blvd
Tampa, FL 33607-6307
Phone (813) 636-8354

Other practice location 2

13535 Nemours Pkwy
Orlando, FL 32827-7402
Phone (407) 567-4000

Other practice location 3

800 Rose St # MS 210A
Lexington, KY 40536-4634
Phone (859) 323-9657

Other identifiers 1

IdentifierTypeStateIssuer
018787000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, KY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041025000918 FL Practitioner - Physician Assistant 0648231449 Reassigns benefits to 1 organization
I20170605003008 KY Practitioner - Physician Assistant 0648231449 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pediatric Physician Services, Inc.Group PAC ID 7113989849, 200 clinicians

Practice addresses (Care Compare)

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

601 5TH St S
Suite 5
St Petersburg, FL 33701-4804
Phone (727) 727-4429

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA2201KYMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Kentucky CurrentSince Apr 27, 2017 Accepting new patients
Pediatric Surgical Group, P.a. Past Accepting new patients

Locations

740 S Limestone
Lexington, KY 40536
Phone (859) 257-3253

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

800 Rose St
#210A
Lexington, KY 40536
Phone (859) 323-9657

Interoperability endpoints

  • Direct secure messaging: jdavis734492@direct.hopkinsmedicine.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1356391973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 5TH ST S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014804",
            "telephone_number": "727-767-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 5TH ST S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014804",
            "telephone_number": "727-767-6666"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3001 W Dr Martin Luther King Jr Blvd",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336076307",
            "country_code": "US",
            "telephone_number": "813-636-8354",
            "fax_number": "813-443-8160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13535 Nemours Pkwy",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328277402",
            "country_code": "US",
            "telephone_number": "407-567-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Rose St # MS 210A",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405364634",
            "country_code": "US",
            "telephone_number": "859-323-9657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JENNIFER",
        "middle_name": "ARENAS",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "PA2201",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9102922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018787000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.