Individual provider Active NPI

Jade Annique Carter

  • Dentist
  • Tampa, FL
National Provider Identifier
1487968467
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN22253 Issued in FL
Practice address
5611 Sheldon Rd
Tampa, FL 33615-3532
Phone
(813) 397-5300
Fax
(813) 405-3709
NPI assigned
Aug 2, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 055835 NY
Dentist 122300000X DN22253 FL Primary

Addresses

Primary practice location

5611 Sheldon Rd
Tampa, FL 33615-3532

Mailing address

PO Box 82969
Tampa, FL 33682-2969
Phone (813) 866-0930

Other identifiers 1

IdentifierTypeStateIssuer
018536400MedicaidFL

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210708001037 FL Practitioner - Dentist 0749589364 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN22253FLMDDentist
055835NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa Family Health Centers Inc CurrentSince Jun 28, 2021 Accepting new patients
Tampa Family Health Centers Inc Current Accepting new patients
Tampa Family Health Centers, Inc CurrentSince Jun 28, 2021 Accepting new patients

Locations

7814 N Dale Mabry Hwy
Tampa, FL 33614
Phone (813) 405-3939

3901 S West Shore Blvd
Tampa, FL 33611
Phone (813) 712-1940

5611 Sheldon Rd
Tampa, FL 33615
Phone (813) 397-5320

302 W Fletcher Ave
Tampa, FL 33612

Networks

  • Freedom Health HMO Network

Organizations & group practices 3

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": "1280707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1487968467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 82969",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336822969",
            "telephone_number": "813-866-0930",
            "fax_number": "813-405-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5611 SHELDON RD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336153532",
            "telephone_number": "813-397-5300",
            "fax_number": "813-405-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARTER",
        "first_name": "JADE",
        "middle_name": "ANNIQUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-02",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "055835",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN22253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018536400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.