Active NPI
Kristel Iantha Sanjuan, MD
- Family Medicine Physician
- St Petersburg, FL
National Provider Identifier
1851578256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME105153
- Practice address
- 111 Second Ave NE 1500
Jsa Healthcare
St Petersburg, FL 33701 - Phone
- (727) 828-2370
- Fax
- (727) 568-6011
- NPI assigned
- Jan 28, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 002462 | GA | |
| Family Medicine Physician | 207Q00000X | ME105153 | FL | Primary |
Addresses
Primary practice location
111 Second Ave NE 1500
Jsa Healthcare
St Petersburg, FL 33701
Mailing address
111 Second Ave NE 1500
Jsa Healthcare
St Petersburg, FL 33701
Phone (727) 828-2370
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME105153 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optumcare Florida LLC | Family Medicine | Past | Accepting new patients |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
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.
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258502400000",
"number": "1851578256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 SECOND AVE NE 1500",
"address_2": "JSA HEALTHCARE",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "33701",
"telephone_number": "727-828-2370",
"fax_number": "727-568-6011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 SECOND AVE NE 1500",
"address_2": "JSA HEALTHCARE",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "33701",
"telephone_number": "727-828-2370",
"fax_number": "727-568-6011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANJUAN",
"first_name": "KRISTEL",
"middle_name": "IANTHA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-28",
"last_updated": "2009-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "002462",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME105153",
"primary": true
}
],
"identifiers": [],
"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 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.