Active NPI
Xiaoming Shawn Wan, M.D.
- Family Medicine Physician
- St Petersburg, FL
National Provider Identifier
1760435994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME87645
- Practice address
- 3201 66TH St N
St Petersburg, FL 33710-1510 - Phone
- (727) 527-7035
- Fax
- (727) 533-5993
- NPI assigned
- May 18, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME87645 | FL | Primary |
Addresses
Primary practice location
3201 66TH St N
St Petersburg, FL 33710-1510
Mailing address
PO Box 1830
Clearwater, FL 33757-1830
Phone (727) 532-1355
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 267680000 | Medicaid | FL | |
| P00294413 | Other | FL | RAILROAD MEDICARE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baycare Medical Group Pediatric Walk-in Care LLC | Past | Accepting new patients | |
| Physical Medicine Center | Past | Accepting new patients | |
| Jessica J Wilson Chan D O PA | Past | Accepting new patients |
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Organizations & group practices 3
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.
-
- Pediatrics Physician
- Lutz, FL
- NPI 1861850117
-
- General Practice Physician
- Tampa, FL
- NPI 1457995953
-
- Multi-Specialty Clinic/Center
- Tampa, FL
- NPI 1902810963
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446508800000",
"number": "1760435994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1830",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337571830",
"telephone_number": "727-532-1355",
"fax_number": "727-266-4928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 66TH ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337101510",
"telephone_number": "727-527-7035",
"fax_number": "727-533-5993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAN",
"first_name": "XIAOMING",
"middle_name": "SHAWN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2015-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME87645",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "267680000",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE NUMBER",
"identifier": "P00294413",
"state": "FL"
}
],
"endpoints": [],
"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 Nov 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.