Individual provider Active NPI

Mary C Kawalya, ARNP

  • Family Nurse Practitioner
  • St Petersburg, FL
National Provider Identifier
1497256861
Registry record updated Mar 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9214663 Issued in FL
Practice address
1839 Central Ave
St Petersburg, FL 33713-8900
Phone
(727) 820-1040
Fax
(727) 821-7213
NPI assigned
Feb 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9214663 FL Primary

Addresses

Primary practice location

1839 Central Ave
St Petersburg, FL 33713-8900

Mailing address

1839 Central Ave
St Petersburg, FL 33713-8900
Phone (727) 820-1040

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
I20180308001674 FL Practitioner - Nurse Practitioner 6002177094 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medical Director Services PCGroup PAC ID 0042501116, 79 clinicians

Practice addresses (Care Compare)

3648 University Blvd S
Jacksonville, FL 32216-4208
Phone (718) 534-0689

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9214663FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Director Services PC CurrentSince Aug 1, 2023 Accepting new patients
Professional Health Care of Pinellas LLC CurrentSince Feb 26, 2018 Accepting new patients
Professional Health Care of Pinellas Inc. CurrentSince Feb 26, 2018 Accepting new patients
Longevity Clinical LTC Associates of Florida PLLC CurrentSince Apr 11, 2022 Accepting new patients
Pioneer Medical Group, PL Family CurrentSince Sep 1, 2021 Accepting new patients

Locations

3648 University Blvd S
Jacksonville, FL 32216
Phone (904) 345-7185

4300 Rock Island Rd
Lauderhill, FL 33319
Phone (954) 309-1126

1404 NW 22nd St
Miami, FL 33142
Phone (305) 325-1050

11770 US Highway 1
Ste 102E
Palm Beach Gardens, FL 33408
Phone 56181524270

1839 Central Ave
St Petersburg, FL 33713
Phone (727) 322-1054

2970 Scarlet Rd
Winter Park, FL 32792
Phone (350) 250-2435

38250 A Ave
Zephyrhills, FL 33542
Phone (813) 732-5608

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIJHAA

Organizations & group practices 5

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": "1519171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521158400000",
    "number": "1497256861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337138900",
            "telephone_number": "727-820-1040",
            "fax_number": "727-821-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337138900",
            "telephone_number": "727-820-1040",
            "fax_number": "727-821-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAWALYA",
        "first_name": "MARY",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-21",
        "last_updated": "2018-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9214663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.