Individual provider Active NPI

Eryn Croft Lelaulu, PA-C

  • Physician Assistant
  • Clearwater, FL
National Provider Identifier
1629551817
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9111622 Issued in FL
Practice address
611 S Fort Harrison Ave # 354
Clearwater, FL 33756-5301
Phone
(727) 298-6612
Fax
(727) 461-8085
NPI assigned
Sep 13, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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 PA9111622 FL Primary

Addresses

Primary practice location

611 S Fort Harrison Ave # 354
Clearwater, FL 33756-5301

Mailing address

611 S Fort Harrison Ave Ste 354
Clearwater, FL 33756-5301
Phone (727) 298-6612

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
I20190129003428 FL Practitioner - Physician Assistant 3476890476 Reassigns benefits to 1 organization

National Provider Directory

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

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": "1536796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1629551817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 S FORT HARRISON AVE STE 354",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337565301",
            "telephone_number": "727-298-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 S FORT HARRISON AVE # 354",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337565301",
            "telephone_number": "727-298-6612",
            "fax_number": "727-461-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LELAULU",
        "first_name": "ERYN",
        "middle_name": "CROFT",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-13",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.