NPIMap

Organization Active NPI

Clinicare Clinical Services, Inc.

Doing business as Clinicare Diagnostic Medical Services

  • Nurse Practitioner
  • Clearwater, FL
National Provider Identifier
1609818145
Registry record updated Sep 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
CLINICARE CLINICAL SERVICES, INC.
Doing business as
Clinicare Diagnostic Medical Services
Practice address
2112 Sunnydale Blvd Ste B
Clearwater, FL 33765-1207
Phone
(727) 796-2904
Fax
(866) 961-5586
NPI assigned
Jun 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2021

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

Authorized official

Name
Ms. Kimberly Ann Johns
Title
Ceo
Phone
(727) 796-2904

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Disorder Diagnostic Clinic/Center 261QS1200X
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

2112 Sunnydale Blvd Ste B
Clearwater, FL 33765-1207

Mailing address

PO Box 16264
Clearwater, FL 33766-6264
Phone (727) 796-2904

Other identifiers 2

IdentifierTypeStateIssuer
HCC8722OtherFLFLORIDA AHCA HEALTHCARE CLINIC LICENSE
0010YOtherFLFLORIDA BLUE CROSS

Other names 1

  • Clinicare Diagnostic Medical Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100325000817 FL Part B Supplier - Clinic/Group Practice 3870505092 Receives reassigned benefits from 12 practitioners
Practice locations: Clearwater, FL

National Provider Directory

National Provider Directory

Locations

2112 Sunnydale Blvd
Ste B
Clearwater, FL 33765
Phone (727) 796-2904

2194 Main St
Ste 1
Dunedin, FL 34698
Phone (866) 961-5589

Networks

  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630800000000",
    "number": "1609818145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16264",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337666264",
            "telephone_number": "727-796-2904",
            "fax_number": "727-796-2965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 SUNNYDALE BLVD STE B",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337651207",
            "telephone_number": "727-796-2904",
            "fax_number": "866-961-5586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICARE CLINICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2021-09-05",
        "certification_date": "2021-09-05",
        "status": "A",
        "authorized_official_last_name": "JOHNS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "727-796-2904",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA AHCA HEALTHCARE CLINIC LICENSE",
            "identifier": "HCC8722",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE CROSS",
            "identifier": "0010Y",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinicare Diagnostic Medical Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinicare Diagnostic Medical Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.