Individual provider Active NPI

Jessica C Kreps

  • Physician Assistant
  • St Petersburg, FL
National Provider Identifier
1437823473
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9114265 Issued in FL
Practice address
6499 38TH Ave N Ste B2
St Petersburg, FL 33710-1650
Phone
(813) 321-1786
Fax
(813) 321-1787
NPI assigned
Aug 3, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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 PA9114265 FL Primary

Addresses

Primary practice location

6499 38TH Ave N Ste B2
St Petersburg, FL 33710-1650

Mailing address

18228 N US Highway 41
Lutz, FL 33549-4400
Phone (813) 321-1786

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
I20210930001310 FL Practitioner - Physician Assistant 1254738495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suncoast Skin SolutionsGroup PAC ID 7416018221, 102 clinicians

Practice addresses (Care Compare)

32615 US Hwy 19 N
Suite 1
Palm Harbor, FL 34684-3176
Phone (813) 321-1786

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9114265FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Douglas K Pierce MD PA PastSince Oct 18, 2023 Accepting new patients

Networks

  • 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.

NPI Registry JSON

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

{
    "created_epoch": "1627948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1437823473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18228 N US HIGHWAY 41",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335494400",
            "telephone_number": "813-321-1786",
            "fax_number": "813-321-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6499 38TH AVE N STE B2",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337101650",
            "telephone_number": "813-321-1786",
            "fax_number": "813-321-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREPS",
        "first_name": "JESSICA",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-03",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9114265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.