NPIMap

Organization Active NPI

St. Joseph'S Hospital, Inc.

  • Primary Care Clinic/Center
  • St Petersburg, FL
National Provider Identifier
1710036868
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ST. JOSEPH'S HOSPITAL, INC.
Practice address
1201 5TH Ave N Ste 409
St Petersburg, FL 33705-1433
Phone
(813) 870-4460
Fax
(813) 870-4459
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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

Authorized official

Name
Mrs. Lynda A Gorken
Title
Director
Phone
(727) 281-9390

Specialties & licenses 1

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

Addresses

Primary practice location

1201 5TH Ave N Ste 409
St Petersburg, FL 33705-1433

Mailing address

1201 5TH Ave N Ste 409
St Petersburg, FL 33705-1433
Phone (813) 870-4460

Other practice location 1

3050 1st Ave S
St Petersburg, FL 33712-1010
Phone (727) 321-4846

Other identifiers 1

IdentifierTypeStateIssuer
254872100MedicaidFL

Other names 1

  • PINELLAS CARE CLINIC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040130000098 FL Part B Supplier - Clinic/Group Practice 1658274287 Receives reassigned benefits from 14 practitioners
Practice locations: St Petersburg, FL

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0968598St Anthony'S Pinellas Care Clinic1201 5TH Ave N Suite 409, Saint Petersburg, FL 33705Certificate of waiverDec 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
St Josephs Womens Hospi13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

3050 1st Ave S
St Petersburg, FL 33712
Phone (727) 209-3500

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1710036868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 5TH AVE N STE 409",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051433",
            "telephone_number": "813-870-4460",
            "fax_number": "813-870-4459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 5TH AVE N STE 409",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051433",
            "telephone_number": "813-870-4460",
            "fax_number": "813-870-4459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3050 1st Ave S",
            "address_purpose": "LOCATION",
            "city": "St Petersburg",
            "state": "FL",
            "postal_code": "337121010",
            "country_code": "US",
            "telephone_number": "727-321-4846",
            "fax_number": "727-321-3811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. JOSEPH'S HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "GORKEN",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "727-281-9390",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254872100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PINELLAS CARE CLINIC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "PINELLAS CARE CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.