DIAGNOSTIC CLINIC MEDICAL GROUP, INC. (NPI# 1043676034) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043676034 |
| Entity Type | Organization |
| Organization Name | DIAGNOSTIC CLINIC MEDICAL GROUP, INC. |
| Practice Address |
1301 2nd Ave Sw Largo FL 33770-3120 |
| Practice Telephone | 7275818767 |
| Practice Fax Number | 7275818507 |
| Mailing Telephone | 7275818767 |
| Mailing Fax Number | 7275818507 |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2016-04-28 |
| Authorized Official Name | DR. JAMES F RIVENBARK III (CEO) |
| Authorized Official Telephone | 7275818767 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | FLORIDA BLUE | V00EY | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609222405 | Diagnostic Clinic Medical Group, Inc. | Family Medicine | 6776 54th Ave N, Suite B, St Petersburg, FL 33709-1405 | 2016-05-11 |
| 1457686784 | Diagnostic Clinic Medical Group, Inc. | Orthopaedic Surgery | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2009-10-05 |
| 1730232240 | Diagnostic Clinic Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2007-01-19 |
| Street Address |
1301 2ND AVE SW |
| City | LARGO |
| State | FL |
| Zip Code | 33770-3120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407851314 | Diagnostic Clinic Medical Group Inc. | Allergy & Immunology | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2005-06-16 |
| 1952924979 | Jordan Ashley Bennett | Advanced Practice Midwife | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2020-05-26 |
| 1205477072 | Calli Keenan Fodor | Audiologist | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2019-10-03 |
| 1093283145 | Patricia Hanratty | Nurse Practitioner | 1301 2nd Ave Sw, Largo, FL 33770-2298 | 2018-11-07 |
| 1649786781 | Erica Anne Martin | Physician Assistant | 1301 2nd Ave Sw, Largo, FL 33770-2298 | 2017-12-27 |
| 1144736927 | Mladen Nikolic | Nurse Practitioner | 1301 2nd Ave Sw, Largo, FL 33770 | 2017-12-15 |
| 1922524958 | Kimmy Nhut Nguyen | Physician Assistant | 1301 2nd Ave Sw, Largo, FL 33770 | 2017-08-22 |
| 1164959920 | Orthopaedic Associates of West Florida, Pa | Clinic/Center | 1301 2nd Ave Sw, Fl 6, Largo, FL 33770-3120 | 2017-05-11 |
| 1932644580 | Janet A Mccormick | Nurse Practitioner | 1301 2nd Ave Sw, Largo, FL 33770-2298 | 2017-01-05 |
| 1619323417 | Optic Shoppe Dme | Durable Medical Equipment & Medical Supplies | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2016-05-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467005041 | Chelsey Lyn Shepos | Optometrist | 1030 West Bay Dr, Suite 200, Largo, FL 33770 | 2019-07-22 |
| 1407353626 | Michael E Ibrahim | Pharmacist | 1290 West Bay Drive, Largo, FL 33770 | 2018-04-13 |
| 1518413384 | Payton Kuhlenbeck | Anesthesiology | 210 14th Street Sw, Largo, FL 33770 | 2016-08-31 |
| 1639536865 | Ryan Boice | Physical Therapy Assistant | 118 West Bay Drive, Suite 111, Largo, FL 33770 | 2016-01-19 |
| 1508238858 | Alignment Healthcare Florida LLC | Clinic/Center | 1301 2nd Ave., Sw, Largo, FL 33770 | 2015-10-27 |
| 1891161808 | Jessica Nicole Mcglone | Nurse Practitioner | 601 Rosery Rd Ne Apt 1502, Largo, FL 33770 | 2015-08-12 |
| 1033598602 | Demetria Anderson | Counselor | 1301 Seminole Blvd Ste 103, Largo, FL 33770 | 2015-05-28 |
| 1962881821 | Building Blocks Therapy, Pllc | Community/Behavioral Health | 1301 Seminole Blvd Building A Suite 103, Largo, FL 33770 | 2015-05-26 |
| 1457765968 | Summer Moon | Dermatology | 115 Highland Ave N, Largo, FL 33770 | 2014-06-12 |
| 1578982393 | Lauren Elizabeth Grandpre | Emergency Medicine | 201 14th St. Sw, Largo Medical Center Emergency Department, Largo, FL 33770 | 2014-04-09 |
| Find all providers in zip 33770 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376965236 | Virtual Radiology Inc | Clinic/Center | 2520 W Bay Dr, Largo, FL 33770-1935 | 2014-01-13 |
| 1407131055 | Largo Radiology Consultants | Clinic/Center | 2025 Indian Rocks Rd S, Largo, FL 33774-1035 | 2011-10-14 |
| 1104106582 | Largo Radiology Consultants, Pa | Clinic/Center | 201 14th St Sw, Largo, FL 33770-3133 | 2011-08-17 |
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| 1619500881 | Adventhealth West Florida Imaging, Inc. | Clinic/Center | 305 E Brandon Blvd Ste B, Brandon, FL 33511-5222 | 2020-02-17 |
| 1831736768 | Bria Group Inc | Clinic/Center | 880 Nw 13th St Ste 100, Boca Raton, FL 33486-2342 | 2019-12-10 |
| 1235770686 | Clermont Radiology LLC | Clinic/Center | 18 Ne 1st Ave, Ocala, FL 34470-6658 | 2019-10-07 |
| 1609422146 | Dis of Tampa Bay Inc | Clinic/Center | 3635 W Waters Ave, Tampa, FL 33614-2783 | 2019-08-12 |
| 1245891209 | Ohri, LLC | Clinic/Center | 392 Rinehart Rd., Suite 1300, Lake Mary, FL 32746 | 2019-06-21 |
| 1417518481 | Ohri, LLC | Clinic/Center | 5151 Winter Garden Vineland Road., Suite 104, Windermere, FL 34786 | 2019-06-21 |
| 1093273971 | Alfa Diagnostic LLC | Clinic/Center | 21355 E Dixie Hwy Ste 107, Aventura, FL 33180-1239 | 2019-03-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.