DR. JOSE A PRIETO M.D.
NPI 1376573782
Obstetrics & Gynecology - Maternal & Fetal Medicine in St Petersburg, FL
NPI Status: Active since July 03, 2006
Contact Information
625 6TH AVE S
STE 340
ST PETERSBURG, FL
ZIP 33701
Phone: (727) 553-7903
Fax: (727) 553-7905
- Individual
- Male
- Years of Experience 36
- Obstetrics & Gynecology
- Maternal & Fetal Medicine
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About JOSE PRIETO
This page provides the complete NPI Profile along with additional information for Jose Prieto, a women's health care provider established in St Petersburg, Florida with a medical specialization in Obstetrics & Gynecology, focusing in maternal & fetal medicine and more than 36 years of experience. He graduated from University Of Miami, Lm Miller School Of Medicine in 1990. The healthcare provider is registered in the NPI registry with number 1376573782 assigned on July 2006. The practitioner's primary taxonomy code is 207VM0101X with license number ME 70330 (FL). The provider is registered as an individual and his NPI record was last updated 7 years ago.
- NPI
- 1376573782
- Provider Name
- DR. JOSE A PRIETO M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 625 6TH AVE S STE 340 ST PETERSBURG, FL 33701
- Location Phone
- (727) 553-7903
- Location Fax
- (727) 553-7905
- Mailing Address
- 625 6TH AVE S STE 340 ST PETERSBURG, FL 33701
- Mailing Phone
- (727) 553-7903
- Mailing Fax
- (727) 553-7905
- Medical School Name
- UNIVERSITY OF MIAMI, LM MILLER SCHOOL OF MEDICINE
- Graduation Year
- 1990
- Is Sole Proprietor?
- No
- Enumeration Date
- 07-03-2006
- Last Update Date
- 02-06-2019
- Code Navigator
Women's health care providers like Jose Prieto treat and diagnose diseases and conditions that affect a woman's physical and emotional health. Women's health professionals come from a variety of different specialties, including obstetrician/gynecologists, general surgeons, perinatologists, physician assistants, nurse practitioners or nurse midwives. A women's health provider might help you with family planning, breast care, pregnancy and child birth, osteoporosis, menopause, heart disease, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Obstetrics & Gynecology Maternal & Fetal Medicine
- Taxonomy Code
- 207VM0101X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- ME 70330
- License State
- FL
- Taxonomy Description
- An obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowledge of the obstetrical, medical and surgical complications of pregnancy and their effect on both the mother and the fetus. The specialist also possesses expertise in the most current diagnostic and treatment modalities used in the care of patients with complicated pregnancies.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- AmeriHealth Caritas Next Bronze Essential + No Referrals - HMO
- AmeriHealth Caritas Next Bronze Premier + No Referrals - HMO
- AmeriHealth Caritas Next Bronze Signature + No Referrals - HMO
- AmeriHealth Caritas Next Gold Premier + No Referrals - HMO
- AmeriHealth Caritas Next Gold Signature + No Referrals - HMO
- AmeriHealth Caritas Next Silver Essential + No Referrals - HMO
- AmeriHealth Caritas Next Silver Premier + No Referrals - HMO
- AmeriHealth Caritas Next Silver Signature + No Referrals - HMO
- AvMed Entrust Bronze 600 (2026) - HMO
- AvMed Entrust Bronze 650 (2026) - HMO
- AvMed Entrust Expanded Bronze Standard (2026) - HMO
- AvMed Entrust Gold 125 (2026) - HMO
- AvMed Entrust Gold 125 Dental+Vision (2026) - HMO
- AvMed Entrust Gold Standard (2026) - HMO
- AvMed Entrust Platinum 25 (2026) - HMO
- AvMed Entrust Platinum 25 Dental+Vision (2026) - HMO
- AvMed Entrust Platinum Standard (2026) - HMO
- AvMed Entrust Silver 350 (2026) - HMO
- BlueOptions Bronze (HSA) 24J01-10 (Rewards / $4 Condition Care Rx) - PPO
- BlueOptions Bronze 24J01-04 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards) - PPO
- BlueOptions Bronze 24J01-06 (Rewards) - PPO
- BlueOptions Bronze 24J01-17 ($50 PCP Visits / Rewards) - PPO
- BlueOptions Bronze 24J01-18S ($50 PCP Visits / Rewards) - PPO
- BlueOptions Gold 24J01-09 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards) - PPO
- BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) - PPO
- BlueOptions Gold 24J01-20S ($30 PCP Visits / $60 Specialist Visits / Rewards) - PPO
- BlueOptions Platinum 24J01-05 ($0 Labs / $15 PCP Visits / $35 Specialist Visits / Rewards) - PPO
- BlueOptions Platinum 24J01-08 ($0 Deductible / $0 Labs / $15 PCP Visits / $25 Specialist Visits / Rewards) - PPO
- BlueCare Bronze (HSA) 24K01-09 (Rewards / $4 Condition Care Rx) - POS
- BlueCare Bronze 24K01-03 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards) - POS
- BlueCare Bronze 24K01-05 (Rewards) - POS
- BlueCare Bronze 24K01-25 ($50 PCP Visits / $75 Specialist Visits / Rewards) - POS
- BlueCare Bronze 24K01-31S ($50 PCP Visits / Rewards) - POS
- BlueCare Bronze 24K02-17 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards) - POS
- BlueCare Bronze 24K02-18 (Rewards) - POS
- BlueCare Bronze 24K02-23 ($50 PCP Visits / $75 Specialist Visits / Rewards) - POS
- BlueCare Bronze 24K02-26S ($50 PCP Visits / Rewards) - POS
- BlueCare Gold 24K01-08 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards) - POS
- Molina Bronze Enhanced 3500 - HMO
- Molina Bronze Enhanced 3500 Plus with Adult Dental and Vision - HMO
- Molina Bronze Enhanced 3500 Plus with Adult Vision - HMO
- Molina Bronze Premier with $0 Medical Deductible - HMO
- Molina Bronze Premier with $0 Medical Deductible Plus with Adult Dental and Vision - HMO
- Molina Bronze Premier with $0 Medical Deductible Plus with Adult Vision - HMO
- Molina Bronze Standard - HMO
- Molina Gold Core 1640 - HMO
- Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
- Molina Gold Core 1640 Plus with Adult Vision - HMO
- Bronze Classic 4700 - HMO
- Bronze Classic 4700 | with AdventHealth - HMO
- Bronze Classic Standard - HMO
- Bronze Classic Standard | with AdventHealth - HMO
- Bronze Elite + PCP Saver Plus - HMO
- Bronze Elite + PCP Saver Plus | with AdventHealth - HMO
- Bronze Simple Breathe Easy with Enhanced COPD Benefits - HMO
- Bronze Simple Chronic Care CKM - HMO
- Bronze Simple Diabetes - HMO
- Gold Classic Standard - HMO
- Wellpoint Essential Bronze 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Bronze 5500 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Bronze 6000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Bronze 7500 ($0 Virtual PCP + $0 Select Drugs + Incentives) Standard - HMO
- Wellpoint Essential Catastrophic (+ Incentives) - HMO
- Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Gold 2000 ($0 Virtual PCP + $0 Select Drugs + Incentives) Standard - HMO
- Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Gold 800 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Silver 1850 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 022803300 | MEDICAID (05) | FL |
Medicare Participation & PECOS Enrollment Status
Jose Prieto is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Jose Prieto is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 2062686041
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20111201000423
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Physician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $32.51 for a new patient copayment and $17.51 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 33701 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $130.04
- Minimum New Patient Price $56
- Maximum New Patient Price $171.84
- Average New Patient Copayment $32.51
- Minimum New Patient Copayment $14
- Maximum New Patient Copayment $42.96
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $70.04
- Minimum Established Patient Price $17.57
- Maximum Established Patient Price $139.16
- Average Established Patient Copayment $17.51
- Minimum Established Patient Copayment $4.39
- Maximum Established Patient Copayment $34.79
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Chronic Care and Preventative Care Management for Empaneled Patients | Yes | N/A |
| Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation. | ||
| Implementation of medication management practice improvements | Yes | N/A |
| Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews. | ||
| Measurement and Improvement at the Practice and Panel Level | Yes | N/A |
| Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level. | ||
| Use of decision support and standardized treatment protocols | Yes | N/A |
| Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs. | ||
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1376573782, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 68. The final step is to find the difference between that total and the next multiple of ten (70 - 68 = 2).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 68 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
ST PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
SAINT PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
SAINT PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
ST PETERSBURG, FL 33701
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1376573782, enumerated as an "individual" on July 03, 2006.
The provider is located at 625 6TH AVE S STE 340 ST PETERSBURG, FL 33701 and the phone number is (727) 553-7903.
Obstetrics & Gynecology with taxonomy code 207VM0101X and a focus in Maternal & Fetal Medicine.
The provider might be accepting Accepts: AmeriHealth Caritas Next, AvMed, Florida Blue. Please consult your insurance carrier or call the provider to verify.
