Individual provider Active NPI

Fallon Smith Hayes Banton

  • Family Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1407343569
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME165869 Issued in FL
Practice address
901 22ND Ave S
St Petersburg, FL 33705-2933
Phone
(727) 310-0925
NPI assigned
Apr 15, 2018
Last updated
Dec 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME165869 FL Primary

Addresses

Primary practice location

901 22ND Ave S
St Petersburg, FL 33705-2933

Mailing address

901 22ND Ave S
St Petersburg, FL 33705-2933
Phone (727) 310-0925

Other names 1

  • Fallon Smith Hayes Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address fhayes101865@direct.carilionclinic.org Direct

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231212000952 FL Practitioner - Family Practice 9739437153 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

901 22ND Ave S
Chen Central FL Holdings LLC
St Petersburg, FL 33705-2933
Phone (727) 219-1833

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME165869FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Dec 1, 2023 Accepting new patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Dec 1, 2023 Accepting new patients

Locations

855 S Highland Ave
Clearwater, FL 33756
Phone (727) 219-1833

4715 S Florida Ave
Lakeland, FL 33813
Phone (863) 209-7003

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

901 22nd Ave S
St Petersburg, FL 33705
Phone (727) 310-0925

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: fhayes101865@direct.carilionclinic.org

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, 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": "1523750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1407343569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 22ND AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337052933",
            "telephone_number": "727-310-0925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 22ND AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337052933",
            "telephone_number": "727-310-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYES BANTON",
        "first_name": "FALLON",
        "middle_name": "SMITH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-15",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME165869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fhayes101865@direct.carilionclinic.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "796 Old Franklin Tpke",
            "city": "Rocky Mount",
            "state": "VA",
            "country_code": "US",
            "postal_code": "241515507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "FALLON",
            "last_name": "HAYES",
            "middle_name": "SMITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.