Active NPI
Jack Dorian Bartel, PSY.D.
- Clinical Psychologist
- St Petersburg, FL
National Provider Identifier
1356990683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY10541
- Practice address
- 163 5TH Ave NE
St Petersburg, FL 33701-3015 - Phone
- (689) 210-4095
- NPI assigned
- Sep 9, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY10541 | FL | Primary |
Addresses
Primary practice location
163 5TH Ave NE
St Petersburg, FL 33701-3015
Mailing address
163 5TH Ave NE FL 33701
St Petersburg, FL 33701-3015
Phone (689) 210-4095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY10541 | FL | MD | Clinical Psychologist |
Interoperability endpoints
- jack.bartel.1@30520.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1767312000000",
"number": "1356990683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "163 5TH AVE NE FL 33701",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337013015",
"telephone_number": "689-210-4095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 5TH AVE NE",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337013015",
"telephone_number": "689-210-4095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARTEL",
"first_name": "JACK",
"middle_name": "DORIAN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-09",
"last_updated": "2026-01-02",
"certification_date": "2026-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY10541",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.