WATERS EDGE MEDICAL CLINIC TAMPA LLC
NPI 1265054803
Clinic/Center - Multi-Specialty in St Petersburg, FL
About Waters Edge Medical Clinic Tampa Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WATERS EDGE MEDICAL CLINIC TAMPA LLC (NPI 1265054803) is a healthcare organization registered as a multi-specialty in St Petersburg, Florida and active in the NPI registry since May 2020. The organization lists Vida Vodopalas-puodziunas, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Waters Edge Medical Clinic Tampa Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Waters Edge Medical Clinic Tampa LLC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Waters Edge Medical Clinic Tampa LLC's NPI number?
The NPI number for Waters Edge Medical Clinic Tampa LLC is 1265054803. It was assigned to this organization in the NPPES registry on May 16, 2020.
Where is Waters Edge Medical Clinic Tampa LLC located?
Waters Edge Medical Clinic Tampa LLC is located at 1700 66th St N Ste 304, St Petersburg, FL 33710. The listed phone number is (727) 550-0855.
What is Waters Edge Medical Clinic Tampa LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.
Is Waters Edge Medical Clinic Tampa LLC enrolled in Medicare?
Yes. Waters Edge Medical Clinic Tampa LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Waters Edge Medical Clinic Tampa LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Waters Edge Medical Clinic Tampa LLC, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Waters Edge Medical Clinic Tampa LLC was last updated on August 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Waters Edge Medical Clinic Tampa Llc · NPI 1265054803
Multi-Specialty organization in St Petersburg, Florida. Organization record, active in the CMS NPPES registry since May 16, 2020.
## Identity
- **NPI:** 1265054803 (Entity type: Organization)
- **Enumerated:** May 16, 2020
- **Primary specialty:** Clinic/Center - Multi-Specialty · taxonomy 261QM1300X
- **Organization subpart:** No
- **Authorized official:** Vida Vodopalas-Puodziunas, OWNER
## Practice location
- **Address:** 1700 66TH ST N STE 304, St Petersburg, FL 33710-5500
- **Phone:** (727) 550-0855
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 2 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 23, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1265054803) · Data from the CMS NPPES public registry.