Individual provider Active NPI

Clara Louise Culpepper

  • Surgical Physician Assistant
  • St Petersburg, FL
National Provider Identifier
1396521928
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9118373 Issued in FL
Practice address
603 7TH St S
St Petersburg, FL 33701-4719
Phone
(727) 893-6254
Fax
(727) 553-7158
NPI assigned
Sep 8, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Surgical Physician Assistant 363AS0400X PA9118373 FL Primary

Addresses

Primary practice location

603 7TH St S
St Petersburg, FL 33701-4719

Mailing address

603 7TH St S
St Petersburg, FL 33701-4719
Phone (727) 893-6254

Other practice location 1

701 6th St S
St Petersburg, FL 33701-4814
Phone (817) 262-3169

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240224000167 FL Practitioner - Physician Assistant 3971948431 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ohi West Medical Group LLCGroup PAC ID 2668882507, 200 clinicians

Practice addresses (Care Compare)

603 7TH St S
St Petersburg, FL 33701-4719

701 6TH St S
St Petersburg, FL 33701-4814
Phone (727) 823-1234

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9118373FLMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ohi West Medical Group, LLC CurrentSince Feb 1, 2024 Accepting new patients

Locations

603 7th St S
St Petersburg, FL 33701
Phone (727) 553-7750

701 6th St S
St Petersburg, FL 33701
Phone (727) 450-1144

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1694131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1396521928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 7TH ST S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014719",
            "telephone_number": "727-893-6254",
            "fax_number": "727-553-7158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 7TH ST S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014719",
            "telephone_number": "727-893-6254",
            "fax_number": "727-553-7158"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 6th St S",
            "address_purpose": "LOCATION",
            "city": "St Petersburg",
            "state": "FL",
            "postal_code": "337014814",
            "country_code": "US",
            "telephone_number": "817-262-3169",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CULPEPPER",
        "first_name": "CLARA",
        "middle_name": "LOUISE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-08",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9118373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.