Individual provider Active NPI

John Wesley Elliott III, CPNP-AC

  • Pediatric Nurse Practitioner
  • St Petersburg, FL
National Provider Identifier
1821496324
Registry record updated Sep 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
ARNP9398367 Issued in FL
Practice address
601 5TH St S
St Petersburg, FL 33701-4804
Phone
(727) 767-3153
Fax
(727) 767-2265
NPI assigned
Dec 15, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Pediatric Nurse Practitioner 363LP0222X COA-16296-NP OH
Pediatric Nurse Practitioner 363LP0200X ARNP9398367 FL Primary

Addresses

Primary practice location

601 5TH St S
St Petersburg, FL 33701-4804

Mailing address

501 6TH Ave S
St Petersburg, FL 33701-4634
Phone (727) 767-3153

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180123000256 FL Practitioner - Nurse Practitioner 0547529414 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
COA-16296-NPOHMDCritical Care Pediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Physician Services, Inc. CurrentSince Dec 16, 2017 Accepting new patients

Locations

601 5th St S
Ste 5
St Petersburg, FL 33701
Phone (727) 727-4429

601 5th St S
St Petersburg, FL 33701
Phone (727) 767-3333

501 6th Ave S
St Petersburg, FL 33701
Phone (727) 344-6060

Interoperability endpoints

  • Direct secure messaging: jelliott732516@direct.hopkinsmedicine.org

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1418601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442275200000",
    "number": "1821496324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014634",
            "telephone_number": "727-767-3153",
            "fax_number": "727-767-2265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 5TH ST S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014804",
            "telephone_number": "727-767-3153",
            "fax_number": "727-767-2265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "JOHN",
        "middle_name": "WESLEY",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "CPNP-AC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-15",
        "last_updated": "2015-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "OH",
            "license": "COA-16296-NP",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP9398367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.