NPIMap

Individual provider Active NPI

Carol Tanner-St. James, M.D.

  • Family Medicine Physician
  • Daytona Beach, FL
National Provider Identifier
1740478197
Registry record updated Apr 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME0047427 Issued in FL
Practice address
1890 Lpga Blvd
170
Daytona Beach, FL 32117-7130
Phone
(386) 274-3354
Fax
(386) 274-5564
NPI assigned
Oct 11, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 13, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME0047427 FL Primary

Addresses

Primary practice location

1890 Lpga Blvd
170
Daytona Beach, FL 32117-7130

Mailing address

1890 Lpga Blvd
170
Daytona Beach, FL 32117-7130
Phone (386) 274-3354

Other identifiers 2

IdentifierTypeStateIssuer
04160OtherFLBLUE CROSS BLUE SHIELD
ME0047427OtherFLSTATE LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041116001134 FL Practitioner - Family Practice 5395709968 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Florida College of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adventhealth Primary Care Network IncGroup PAC ID 1557722410, 428 clinicians

Practice addresses (Care Compare)

1474 W Granada Blvd
Suite 455
Ormond Beach, FL 32174-8240
Phone (386) 231-4685

661 E Altamonte Dr
Suite 115
Altamonte Springs, FL 32701-5102
Phone (407) 831-4040

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0047427FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventhealth Primary Care Network Inc Family Medicine CurrentSince Aug 1, 2023 Accepting new patients
Stand-Up MRI & Diagnostic Center Inc PastSince Jun 1, 2008 Accepting new patients

Locations

661 E Altamonte Dr
Ste 115
Altamonte Springs, FL 32701
Phone (407) 831-4040

1890 Lpga Blvd
Ste 170
Daytona Beach, FL 32117
Phone (386) 231-3284

Interoperability endpoints

  • Direct secure messaging: ctannerstjames70960@adventhealth.direct-ci.com

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302652800000",
    "number": "1740478197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD",
            "address_2": "170",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177130",
            "telephone_number": "386-274-3354",
            "fax_number": "386-274-5564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD",
            "address_2": "170",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177130",
            "telephone_number": "386-274-3354",
            "fax_number": "386-274-5564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER-ST. JAMES",
        "first_name": "CAROL",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-11",
        "last_updated": "2011-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0047427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "04160",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "ME0047427",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.