NPIMap

Organization Active NPI

Medical Home PL

  • Primary Care Clinic/Center
  • Saint Petersburg, FL
National Provider Identifier
1629485271
Registry record updated Jun 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
ME102187 Issued in FL
Legal business name
MEDICAL HOME PL
Practice address
4401 4TH St N
Saint Petersburg, FL 33703-4728
Phone
(727) 525-4401
Fax
(727) 525-7788
NPI assigned
Jul 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2022

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

Authorized official

Name
Mr. Fred Elton Clark III, M.D.NPI 1609022086
Title
Owner
Phone
(727) 525-4401

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X ME102187 FL Primary

Addresses

Primary practice location

4401 4TH St N
Saint Petersburg, FL 33703-4728

Mailing address

PO Box 7651
Saint Petersburg, FL 33734-7651
Phone (727) 922-0009

Other names 1

  • AllCare Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170725000218 FL Part B Supplier - Clinic/Group Practice 3274803259 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Saint Petersburg, FL; St Petersburg, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Allcare Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654905600000",
    "number": "1629485271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7651",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337347651",
            "telephone_number": "727-922-0009",
            "fax_number": "727-525-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 4TH ST N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337034728",
            "telephone_number": "727-525-4401",
            "fax_number": "727-525-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL HOME PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2022-06-11",
        "certification_date": "2022-06-11",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "ELTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-525-4401",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME102187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AllCare Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AllCare Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2022; 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.