Organization Active NPI

Pinellas County Primary Care and Hospitalists PLLC

  • Internal Medicine Physician
  • Clearwater, FL
National Provider Identifier
1790154714
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PINELLAS COUNTY PRIMARY CARE AND HOSPITALISTS PLLC
Practice address
516 Lakeview Rd
Suite#4
Clearwater, FL 33756-3302
Phone
(727) 461-7908
Fax
(727) 223-5269
NPI assigned
Sep 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Authorized official

Name
Kelly Carlson
Title
Practice Manager
Phone
(727) 444-0407

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

516 Lakeview Rd
Suite#4
Clearwater, FL 33756-3302

Mailing address

1007 Jeffords St Ste 101
Clearwater, FL 33756-4082
Phone (727) 461-7908

Other identifiers 1

IdentifierTypeStateIssuer
015819900MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151104000846 FL Part B Supplier - Clinic/Group Practice 2567772510 Receives reassigned benefits from 8 practitioners
Practice locations: Clearwater, FL

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
10D2103198Pinellas County Primary Care and516 Lakeview Rd Ste 4, Clearwater, FL 33756Certificate of waiverOct 6, 2027

National Provider Directory

National Provider Directory

Locations

1007 Jeffords St
Ste 101
Clearwater, FL 33756
Phone (727) 442-5123

612 Druid Rd E
#B
Clearwater, FL 33756
Phone (727) 443-1122

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GBHCAD

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1442793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1790154714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 JEFFORDS ST STE 101",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337564082",
            "telephone_number": "727-461-7908",
            "fax_number": "727-223-5269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 LAKEVIEW RD",
            "address_2": "SUITE#4",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337563302",
            "telephone_number": "727-461-7908",
            "fax_number": "727-223-5269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINELLAS COUNTY PRIMARY CARE AND HOSPITALISTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-21",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "727-444-0407"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015819900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; 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.