Individual provider Active NPI

Jeffery Dean Thompson, PA C

  • Physician Assistant
  • St Petersburg, FL
National Provider Identifier
1386627255
Registry record updated Sep 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2396 Issued in PA
Practice address
5901 Sun Blvd
Suite 113
St Petersburg, FL 33715-1166
Phone
(727) 867-7910
Fax
(727) 867-6379
NPI assigned
Nov 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2396 PA Primary

Addresses

Primary practice location

5901 Sun Blvd
Suite 113
St Petersburg, FL 33715-1166

Mailing address

5901 Sun Blvd
Suite 113
St Petersburg, FL 33715-1166
Phone (727) 867-7910

Other identifiers 1

IdentifierTypeStateIssuer
291360700MedicaidFL

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
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2396PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
We Care Med Inc PastSince Jan 1, 1990 Accepting new patients

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": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380153600000",
    "number": "1386627255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 SUN BLVD",
            "address_2": "SUITE 113",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337151166",
            "telephone_number": "727-867-7910",
            "fax_number": "727-867-6379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 SUN BLVD",
            "address_2": "SUITE 113",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337151166",
            "telephone_number": "727-867-7910",
            "fax_number": "727-867-6379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "JEFFERY",
        "middle_name": "DEAN",
        "name_prefix": "Mr.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-23",
        "last_updated": "2013-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "2396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291360700",
            "state": "FL"
        }
    ],
    "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 Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.