Individual provider Active NPI

Allison Gina Fahy, MD

  • Pediatric Critical Care Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1609192111
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
143137 Issued in FL
Practice address
501 6TH Ave S
St Petersburg, FL 33701-4634
Phone
(727) 767-4343
NPI assigned
Apr 9, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 125.057267 IL
Pediatrics Physician 208000000X 57248 WI
Pediatrics Physician 208000000X 278765 NY
Pediatric Critical Care Medicine Physician 2080P0203X 143137 FL Primary

Addresses

Primary practice location

501 6TH Ave S
St Petersburg, FL 33701-4634

Mailing address

501 6TH Ave S
St Petersburg, FL 33701-4634

Other practice location 1

750 East Adams St
Syracuse, NY 13210
Phone (315) 464-5450

Other identifiers 1

IdentifierTypeStateIssuer
1609192111MedicaidWI

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240123003879 FL Practitioner - Critical Care (Intensivists)Practitioner - Pediatric Medicine 3870741473 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Pediatric Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pediatric Physician Services, Inc.Group PAC ID 7113989849, 200 clinicians

Practice addresses (Care Compare)

601 5TH St S
Suite 5
St Petersburg, FL 33701-4804
Phone (727) 727-4429

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125.057267ILMDPediatrics Physician
143137FLMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Physician Services, Inc. Pediatrics CurrentSince Dec 16, 2023 Accepting new patients

Locations

601 5th St S
Ste 5
St Petersburg, FL 33701
Phone (727) 727-4429

501 6th Ave S
St Petersburg, FL 33701
Phone (727) 344-6060

Interoperability endpoints

  • Direct secure messaging: afahy733162@direct.hopkinsmedicine.org

Organizations & group practices 1

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": "1270771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1609192111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014634",
            "telephone_number": "727-767-4343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 East Adams St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "13210",
            "country_code": "US",
            "telephone_number": "315-464-5450",
            "fax_number": "315-464-6322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAHY",
        "first_name": "ALLISON",
        "middle_name": "GINA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-09",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125.057267",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "57248",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "278765",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "FL",
            "license": "143137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609192111",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.