Justin Fenner Letourneau, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9108503 Issued in FL

Practice address

5565 Dr Martin Luther King Jr St N
St Petersburg, FL 33703-1203

Phone

(727) 577-1203

Fax

(727) 577-0893

NPI assigned

May 13, 2010

Last updated

Jun 30, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Walter G Griffith Jr MD PAGroup PAC ID 9537237029, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Walter G Griffith Jr MD PA

  • Psychiatry Physician
  • St Petersburg, FL
  • NPI 1578675534
  Medicare reassignment Care Compare group
• MCR Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Parrish, FL
  • NPI 1255376000

  Physician Assistant

  Medicare reassignment NPD
• Psychiatry of Texas PLLC

  dba Psychplus Associates

  • Psychiatry Physician
  • Houston, TX
  • NPI 1013476027

  FL, Physician Assistant

  Medicare reassignment NPD
• Psychplus Medical Associates, PLLC

  • Family Medicine Physician
  • Houston, TX
  • NPI 1558118026

  FL, Physician Assistant

  Medicare reassignment NPD
• Brooks Management Inc

  • Clinical Medical Laboratory
  • Bradenton, FL
  • NPI 1699031880
  Medicare reassignment
• MCR Health, Inc.

  dba Riverside Medical Center

  • Non-Pharmacy Dispensing Site
  • Bradenton, FL
  • NPI 1821878745
  NPD
• Brooks Management

  • Dermatology Physician
  • Bradenton, FL
  • NPI 1093017774
  NPD (past)
• Deanna L Mann, PLLC

  • Family Nurse Practitioner
  • Bradenton, FL
  • NPI 1639716814
  NPD (past)

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

{
    "created_epoch": "1273708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1861710923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 58TH ST W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342095660",
            "telephone_number": "941-388-8997",
            "fax_number": "941-306-5876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5565 DR MARTIN LUTHER KING JR ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337031203",
            "telephone_number": "727-577-1203",
            "fax_number": "727-577-0893"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5860 Ranch Lake Blvd",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Bradenton",
            "state": "FL",
            "postal_code": "342023708",
            "country_code": "US",
            "telephone_number": "941-388-8997",
            "fax_number": "941-306-5876",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16461 Domestic Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339126008",
            "country_code": "US",
            "telephone_number": "877-266-7768",
            "fax_number": "603-952-3900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LETOURNEAU",
        "first_name": "JUSTIN",
        "middle_name": "FENNER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-13",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108503",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9108503",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrianna Leszczynska, APRN
• Cecilia Maria Leth, P.T.
• Letha F Miller Inc
• Letha F Miller, Inc.
• Gianna Leto, M.ED
• Lets Speak - Hablemos
• Todd Kenneth Letzring, D.O.
• Brittany Leuz, CRNA
• Angela Levak, BA
• Level 6 Labs LLC

• Physician Assistant in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.