NPIMap

Organization Active NPI

Kolettis Krew LLC

  • Internal Medicine Physician
  • Clearwater, FL
National Provider Identifier
1457533762
Registry record updated Mar 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
KOLETTIS KREW LLC
Practice address
701 N. Hercules Ave
Ste B
Clearwater, FL 33765-2029
Phone
(727) 738-8410
Fax
(727) 734-6254
NPI assigned
Nov 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2016

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

Authorized official

Name
Dr. Elias M Kolettis, D.O.
Title
Physician
Phone
(727) 738-8410

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X OS0007623 FL
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X FL Primary

Addresses

Primary practice location

701 N. Hercules Ave
Ste B
Clearwater, FL 33765-2029

Mailing address

701 N. Hercules Ave
Ste. B
Clearwater, FL 33765-2029
Phone (727) 738-8410

Other identifiers 3

IdentifierTypeStateIssuer
46556OtherFLBCBS
2161129OtherFLAETNA
255469100MedicaidFL

National Provider Directory

National Provider Directory

Locations

2135 NE Coachman Rd
Clearwater, FL 33765
Phone (727) 738-8410

701 N Hercules Ave
Ste B
Clearwater, FL 33765
Phone (727) 441-2915

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458777600000",
    "number": "1457533762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N. HERCULES AVE",
            "address_2": "STE. B",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337652029",
            "telephone_number": "727-738-8410",
            "fax_number": "727-734-6254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N. HERCULES AVE",
            "address_2": "STE B",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337652029",
            "telephone_number": "727-738-8410",
            "fax_number": "727-734-6254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOLETTIS KREW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2016-03-24",
        "status": "A",
        "authorized_official_last_name": "KOLETTIS",
        "authorized_official_first_name": "ELIAS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "727-738-8410",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "OS0007623",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "46556",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2161129",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255469100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2016; 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.