Individual provider Active NPI

Ann Marie McManus, PA

  • Physician Assistant
  • St Petersburg, FL
National Provider Identifier
1831412774
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9105351 Issued in FL
Practice address
6735 Crosswinds Dr N
St Petersburg, FL 33710-5471
Phone
(727) 548-8500
Fax
(727) 501-7328
NPI assigned
Mar 7, 2010
Last updated
Sep 2, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9105351 FL Primary

Addresses

Primary practice location

6735 Crosswinds Dr N
St Petersburg, FL 33710-5471

Mailing address

6735 Crosswinds Dr N
St Petersburg, FL 33710-5471
Phone (727) 548-8500

Other identifiers 4

IdentifierTypeStateIssuer
100327600MedicaidFL
5230941OtherFLAETNA
3400245OtherFLUNITED
Y04PQOtherFLFLORIDA BLUE

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9105351FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic Clinic Medical Group Inc CurrentSince Jul 1, 2018 Accepting new patients
Radiology Associates of Clearwater PastSince Aug 15, 2021 Accepting new patients

Locations

3131 N McMullen Booth Rd
Clearwater, FL 33761
Phone (727) 341-0551

1615 Pasadena Ave S
Ste 220
South Pasadena, FL 33707
Phone (727) 341-0551

6735 Crosswinds Dr N
St Petersburg, FL 33710
Phone (727) 548-8500

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1267920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1831412774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6735 CROSSWINDS DR N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337105471",
            "telephone_number": "727-548-8500",
            "fax_number": "727-501-7328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6735 CROSSWINDS DR N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337105471",
            "telephone_number": "727-548-8500",
            "fax_number": "727-501-7328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMANUS",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-07",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100327600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5230941",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED",
            "identifier": "3400245",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "Y04PQ",
            "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 Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.