Individual provider Active NPI

Kelly Peak

  • Physician Assistant
  • Tampa, FL
National Provider Identifier
1528816337
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
509 N Fremont Ave Unit 418
Tampa, FL 33606-1297
Phone
(910) 617-2917
NPI assigned
May 7, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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 Primary

Addresses

Primary practice location

509 N Fremont Ave Unit 418
Tampa, FL 33606-1297

Mailing address

509 N Fremont Ave Unit 418
Tampa, FL 33606-1297
Phone (910) 617-2917

Other names 1

  • Kelly Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20241218000241 TN Practitioner - Physician Assistant 1153858956 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Erlanger HealthGroup PAC ID 1153780226, 504 clinicians

Practice addresses (Care Compare)

1755 Gunbarrel Rd
Chattanooga, TN 37421-3185

2600 Taft Hwy
Suite 100
Signal Mountain, TN 37377-2777
Phone (423) 778-9434

979 E 3Rd St
Chattanooga, TN 37403-2136

Hospital & facility affiliations

  • Erlanger Medical Center Hospital, Chattanooga, TN, CCN 440104

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Erlanger Health CurrentSince Nov 25, 2024 Accepting new patients
Erlanger Health CurrentSince Nov 25, 2024 Accepting new patients
Chattanooga Hamilton County Hospital Authority Past Accepting new patients

Locations

979 E 3rd St
Ste C825
Chattanooga, TN 37403
Phone (423) 778-4830

1751 Gunbarrel Rd
Ste 100
Chattanooga, TN 37421
Phone (423) 778-9500

2600 Taft Hwy
Ste 100
Signal Mtn, TN 37377
Phone (423) 778-9434

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1528816337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 N FREMONT AVE UNIT 418",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336061297",
            "telephone_number": "910-617-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 N FREMONT AVE UNIT 418",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336061297",
            "telephone_number": "910-617-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEAK",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "SMITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.