Individual provider Active NPI

Clifford H Threlkeld, DO

  • Anatomic Pathology & Clinical Pathology Physician
  • Orlando, FL
National Provider Identifier
1972582930
Registry record updated Nov 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
OS0006623 Issued in FL
Practice address
8150 Chancellor Dr
Suite 110
Orlando, FL 32809-7691
Phone
(407) 587-4243
Fax
(407) 521-5053
NPI assigned
Jan 10, 2006
Last updated
Nov 5, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X OS0006623 FL Primary
Hematology (Pathology) Physician 207ZH0000X OS6623 FL

Addresses

Primary practice location

8150 Chancellor Dr
Suite 110
Orlando, FL 32809-7691

Mailing address

14275 Midway Rd
Suite 400
Addison, TX 75001-3614
Phone (214) 932-8029

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
I20060417000596 FL Practitioner - Pathology 9032128491 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS6623FLMDHematology (Pathology) Physician
OS0006623FLMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ameripath Hospital Services-Florida LLC Anatomic Pathology & Clinical Pathology CurrentSince Sep 17, 2005 Accepting new patients
Ameripath Hospital Services-Florida LLC Anatomic Pathology & Clinical Pathology CurrentSince Sep 17, 2005 Accepting new patients
Ameripath Florida LLC Current Accepting new patients
Kilpatrick Pathology PA Past Accepting new patients
Ameripath Florida LLC Past Accepting new patients
Ameripath Florida LLC Past Accepting new patients

Locations

1900 Don Wickham Dr
Clermont, FL 34711
Phone (352) 536-8761

201 14th St SW
Largo, FL 33770
Phone (727) 588-5222

8150 Chancellor Dr
Ste 110
Orlando, FL 32809
Phone (407) 587-4243

1701 SE Hillmoor Dr
Ste C11
Port St Lucie, FL 34952
Phone (772) 335-0626

1000 36th St
Vero Beach, FL 32960
Phone (772) 567-1942

14275 Midway Rd
Ste 400
Addison, TX 75001
Phone (214) 932-8018

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Central Florida Health Care IncLakeland, FL, CCN 681067 Federally qualified health center Corporate Officer Jan 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415145600000",
    "number": "1972582930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14275 MIDWAY RD",
            "address_2": "SUITE 400",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013614",
            "telephone_number": "214-932-8029",
            "fax_number": "610-271-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8150 CHANCELLOR DR",
            "address_2": "SUITE 110",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328097691",
            "telephone_number": "407-587-4243",
            "fax_number": "407-521-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THRELKELD",
        "first_name": "CLIFFORD",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-10",
        "last_updated": "2014-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "OS0006623",
            "primary": true
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "FL",
            "license": "OS6623",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.