Individual provider Active NPI

Lily Moore Landry, M.D.

  • Pediatric Critical Care Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1942664917
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
ME162790 Issued in FL
Practice address
501 6TH Ave S
Saint Petersburg, FL 33701-4634
Phone
(727) 767-3728
NPI assigned
Apr 6, 2016
Last updated
Jan 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Cardiology Physician 2080P0202X T6938 TX
Pediatric Critical Care Medicine Physician 2080P0203X ME162790 FL Primary

Addresses

Primary practice location

501 6TH Ave S
Saint Petersburg, FL 33701-4634

Mailing address

501 6TH Ave S
Saint Petersburg, FL 33701-4634
Phone (727) 767-3728

Other practice location 1

6621 Fannin St
Houston, TX 77030-2399
Phone (832) 824-1065

Other practice location 2

2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-8489

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250121003673 FL Practitioner - Critical Care (Intensivists) 5799070892 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
T6938TXMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Physician Services, Inc. Pediatric Cardiology CurrentSince Dec 1, 2024 Accepting new patients

Locations

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

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

Interoperability endpoints

  • Direct secure messaging: llandry1142536@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, 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": "1459900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1942664917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337014634",
            "telephone_number": "727-767-3728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 6TH AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337014634",
            "telephone_number": "727-767-3728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6621 Fannin St",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770302399",
            "country_code": "US",
            "telephone_number": "832-824-1065",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2500 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "601-815-8489",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANDRY",
        "first_name": "LILY",
        "middle_name": "MOORE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-06",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "TX",
            "license": "T6938",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "FL",
            "license": "ME162790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.