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KPW HEALTH LLC
Complete NPI Record 1427559020
Clinic/Center - Multi-Specialty in St Petersburg, FL

NPI Status: Active since February 28, 2018

Contact Information

900 CARILLON PKWY STE 301
ST PETERSBURG, FL
ZIP 33716
Phone: (727) 230-3423
Fax: (217) 636-3056

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Title or Position
  24. Authorized Official Telephone Number
  25. Healthcare Provider Taxonomy Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Other Provider Identifier 1
  28. Other Provider Identifier Type Code 1
  29. Other Provider Identifier Issuer 1
  30. Other Provider Identifier 2
  31. Other Provider Identifier Type Code 2
  32. Other Provider Identifier State 2
  33. Other Provider Identifier 3
  34. Other Provider Identifier Type Code 3
  35. Other Provider Identifier Issuer 3
  36. Other Provider Identifier 4
  37. Other Provider Identifier Type Code 4
  38. Other Provider Identifier Issuer 4
  39. Other Provider Identifier 5
  40. Other Provider Identifier Type Code 5
  41. Other Provider Identifier Issuer 5
  42. Other Provider Identifier 6
  43. Other Provider Identifier Type Code 6
  44. Other Provider Identifier Issuer 6
  45. Other Provider Identifier 7
  46. Other Provider Identifier Type Code 7
  47. Other Provider Identifier Issuer 7
  48. Other Provider Identifier 8
  49. Other Provider Identifier Type Code 8
  50. Other Provider Identifier Issuer 8
  51. Other Provider Identifier 9
  52. Other Provider Identifier Type Code 9
  53. Other Provider Identifier Issuer 9
  54. Other Provider Identifier 10
  55. Other Provider Identifier Type Code 10
  56. Other Provider Identifier Issuer 10
  57. Other Provider Identifier 11
  58. Other Provider Identifier Type Code 11
  59. Other Provider Identifier Issuer 11
  60. Other Provider Identifier 12
  61. Other Provider Identifier Type Code 12
  62. Other Provider Identifier Issuer 12
  63. Other Provider Identifier 13
  64. Other Provider Identifier Type Code 13
  65. Other Provider Identifier Issuer 13
  66. Other Provider Identifier 14
  67. Other Provider Identifier Type Code 14
  68. Other Provider Identifier Issuer 14
  69. Other Provider Identifier 15
  70. Other Provider Identifier Type Code 15
  71. Other Provider Identifier Issuer 15
  72. Other Provider Identifier 16
  73. Other Provider Identifier Type Code 16
  74. Other Provider Identifier Issuer 16
  75. Other Provider Identifier 17
  76. Other Provider Identifier Type Code 17
  77. Other Provider Identifier Issuer 17
  78. Other Provider Identifier 18
  79. Other Provider Identifier Type Code 18
  80. Other Provider Identifier Issuer 18
  81. Other Provider Identifier 19
  82. Other Provider Identifier Type Code 19
  83. Other Provider Identifier Issuer 19
  84. Other Provider Identifier 20
  85. Other Provider Identifier Type Code 20
  86. Other Provider Identifier Issuer 20
  87. Other Provider Identifier 21
  88. Other Provider Identifier Type Code 21
  89. Other Provider Identifier Issuer 21
  90. Other Provider Identifier 22
  91. Other Provider Identifier Type Code 22
  92. Other Provider Identifier Issuer 22
  93. Other Provider Identifier 23
  94. Other Provider Identifier Type Code 23
  95. Other Provider Identifier Issuer 23
  96. Other Provider Identifier 24
  97. Other Provider Identifier Type Code 24
  98. Other Provider Identifier Issuer 24
  99. Other Provider Identifier 25
  100. Other Provider Identifier Type Code 25
  101. Other Provider Identifier Issuer 25
  102. Other Provider Identifier 26
  103. Other Provider Identifier Type Code 26
  104. Other Provider Identifier Issuer 26
  105. Other Provider Identifier 27
  106. Other Provider Identifier Type Code 27
  107. Other Provider Identifier Issuer 27
  108. Other Provider Identifier 28
  109. Other Provider Identifier Type Code 28
  110. Other Provider Identifier Issuer 28
  111. Other Provider Identifier 29
  112. Other Provider Identifier Type Code 29
  113. Other Provider Identifier Issuer 29
  114. Is Organization Subpart
  115. Authorized Official Credential Text
  116. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1427559020. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1427559020
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 900 CARILLON PKWY STE 301
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: ST PETERSBURG
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: FL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 337161115
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7272303423
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 2176363056
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 900 CARILLON PKWY STE 301
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: ST PETERSBURG
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: FL
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 337161115
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7272303423
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 2176363056
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 2/28/2018
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 9/19/2024
The date that a record was last updated or changed.
Authorized Official Last Name: WESTON
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: KHALILAH
The first name of the authorized official.
Authorized Official Title or Position: OWNER
The title or position of the authorized official.
Authorized Official Telephone Number: 7346575407
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QM1300X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 61101
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 1: HUMANA, INC
Other Provider Identifier 2: MC010
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: FL
Other Provider Identifier 3: 14163
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 3: WELLCARE FLORIDA
Other Provider Identifier 4: 39026
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 4: UMR
Other Provider Identifier 5: 59274
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 5: AVEMED HEALTH PLAN
Other Provider Identifier 6: 62308
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 6: CIGNA
Other Provider Identifier 7: 64157
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 7: MERITAIN HEALTH
Other Provider Identifier 8: 13551
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 8: GHI/EMBLEM HEALTH PLAN
Other Provider Identifier 9: 28804
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 9: AMERIGROUP
Other Provider Identifier 10: 68069
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 10: SUNSHINE MEDICAID
Other Provider Identifier 11: WELLM2
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 11: WELLMED/UNITED HEALTH CARE
Other Provider Identifier 12: 25133
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 12: COVENTRY HEALTH CARE
Other Provider Identifier 13: 37602
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 13: GOLDEN RULE INSURANCE PLAN
Other Provider Identifier 14: 36273
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 14: AARP- UHC OVATIONS INSURANCE SOLUTIONS
Other Provider Identifier 15: 80214
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 15: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 15: CHAMPVA
Other Provider Identifier 16: BS022
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 16: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 16: BLUE SHIELD FLORIDA
Other Provider Identifier 17: 20133
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 17: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 17: OPTIMUM INSURANCE PLAN
Other Provider Identifier 18: 41212
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 18: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 18: FREEDOM HEALTH INSURANCE PLAN
Other Provider Identifier 19: 44054
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 19: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 19: GEHA
Other Provider Identifier 20: 75261
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 20: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 20: TPA
Other Provider Identifier 21: 87726
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 21: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 21: UNITED HEALTH CARE
Other Provider Identifier 22: 06111
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 22: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 22: OXFORD HEALTH PLAN
Other Provider Identifier 23: 27094
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 23: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 23: SIMPLY HEALTH CARE/ CLEAR HEALTH ALLIANCE
Other Provider Identifier 24: 95019
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 24: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 24: HEALTH FIRST HEALTH PLANS
Other Provider Identifier 25: 77003
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 25: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 25: PRESTIGE
Other Provider Identifier 26: 14163
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 26: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 26: STAYWELL HEALTH PLAN
Other Provider Identifier 27: 60054
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 27: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 27: AETNA MEDICARE
Other Provider Identifier 28: 60054
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 28: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 28: AETNA
Other Provider Identifier 29: 62308
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 29: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 29: GREAT WEST PPO
Is Organization Subpart: N
Authorized Official Credential Text: MD
NPI Certification Date: 9/19/2024