Active NPI
Katrina Potithavoranant
- Medical Physician Assistant
- St Petersburg, FL
National Provider Identifier
1710348479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA9112237
- Practice address
- 620 10TH St N Ste 1E
Saint Petersburg, FL 33705-1407 - Phone
- (727) 824-3120
- NPI assigned
- Mar 9, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA9112237 | FL | Primary |
Addresses
Primary practice location
620 10TH St N Ste 1E
Saint Petersburg, FL 33705-1407
Mailing address
620 10TH St N Ste 1E
Saint Petersburg, FL 33705-1407
Phone (727) 824-3120
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104661300 | Medicaid | FL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Katrina.PotithavoranantPA@direct.mybaycare.org | Health Information Exchange (HIE) | BayCare Medical Group, Inc. |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2461 Enterprise Rd
Suite C
Clearwater, FL 33763-1726
Phone (727) 725-5060
620 10TH St N
St Petersburg, FL 33705-1407
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baycare Medical Group, Inc. | Current | Accepting new patients | |
| Baycare Medical Group, Inc. | Physician Assistant | Past | Accepting new patients |
Locations
2995 Drew St
Fl 2
Clearwater, FL 33759
Phone (727) 315-7234
2461 Enterprise Rd
Ste C
Clearwater, FL 33763
Phone (727) 725-5060
6633 Forest Ave
Ste 105
New Prt Rchy, FL 34653
Phone (727) 845-4300
620 10th St N
Ste 1E
St Petersburg, FL 33705
Phone (727) 824-3120
Interoperability endpoints
- katrina.potithavoranantpa@direct.mybaycare.org
Organizations & group practices 2
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.
-
- General Practice Physician
- Clearwater, FL
- NPI 1043269871
Physician Assistant
-
- Family Medicine Physician
- Clearwater, FL
- NPI 1659720837
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Largo, FL
- NPI 1033117007
-
dba Morton Plant Hospital
- General Acute Care Hospital
- Clearwater, FL
- NPI 1376529743
-
dba St. Anthonys Hospital
- General Acute Care Hospital
- St Petersburg, FL
- NPI 1427024942
-
dba St. Joseph's Women's Hospital
- General Acute Care Hospital
- Tampa, FL
- NPI 1346519816
-
dba St. Joseph's Hospital
- General Acute Care Hospital
- Tampa, FL
- NPI 1881632818
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692230400000",
"number": "1710348479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 10TH ST N STE 1E",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337051407",
"telephone_number": "727-824-3120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 10TH ST N STE 1E",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337051407",
"telephone_number": "727-824-3120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTITHAVORANANT",
"first_name": "KATRINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-09",
"last_updated": "2023-08-17",
"certification_date": "2023-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "PA9112237",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104661300",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Katrina.PotithavoranantPA@direct.mybaycare.org",
"affiliation": "Y",
"affiliationName": "BayCare Medical Group, Inc.",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "2995 Drew St Fl 2",
"city": "Clearwater",
"state": "FL",
"country_code": "US",
"postal_code": "337593012",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}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 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.