DIAGNOSTIC CLINIC MEDICAL GROUP INC (NPI# 1124440912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124440912 |
| Entity Type | Organization |
| Organization Name | DIAGNOSTIC CLINIC MEDICAL GROUP INC |
| Practice Address |
3165 N Mcmullen Booth Rd Building B Clearwater FL 33761-2032 |
| Practice Telephone | 7275818767 |
| Practice Fax Number | 7275818507 |
| Mailing Telephone | 7275818767 |
| Mailing Fax Number | 7275818507 |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2016-04-28 |
| Authorized Official Name | DR. JAMES F RIVENBARK III (CEO) |
| Authorized Official Telephone | 7275818767 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians | ||
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians |
| Street Address |
3165 N MCMULLEN BOOTH RD BUILDING B |
| City | CLEARWATER |
| State | FL |
| Zip Code | 33761-2032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285631416 | Quantum Genesis Inc. | Family Medicine | 3165 N Mcmullen Booth Rd, Suite H, Clearwater, FL 33761-2032 | 2005-07-01 |
| 1235672312 | Jennifer Kay | Physician Assistant | 3165 N Mcmullen Booth Rd, Ste H, Clearwater, FL 33761-2032 | 2016-11-22 |
| 1215304613 | Synergistiq Integrative Health P A | Clinic/Center | 3165 N Mcmullen Booth Rd, Suite D-2, Clearwater, FL 33761-2032 | 2015-09-01 |
| 1194034348 | Grasso Anesthesia Services and Staffing Inc. | Nurse Anesthetist, Certified Registered | 3165 N Mcmullen Booth Rd, Building B, Clearwater, FL 33761-2032 | 2010-10-05 |
| 1750554648 | Tracy A Riordan | Physical Therapist | 3165 N Mcmullen Booth Rd, Clearwater, FL 33761-2032 | 2008-04-11 |
| 1265601595 | Center for Family Health Wellness and Prevention P A | Family Medicine | 3165 N Mcmullen Booth Rd, Suite C1, Clearwater, FL 33761-2032 | 2008-02-20 |
| 1093904815 | David L. Hicks | Family Medicine | 3165 N Mcmullen Booth Rd, Suite H, Clearwater, FL 33761-2032 | 2007-10-17 |
| 1255483798 | Eduardo R Lazaro | Dentist | 3165 N Mcmullen Booth Rd, Clearwater, FL 33761-2032 | 2007-01-17 |
| 1215088372 | Carlos Manuel Garcia | Internal Medicine | 3165 N Mcmullen Booth Rd, Building B, Clearwater, FL 33761-2032 | 2007-01-16 |
| 1114088028 | Michael L Oneal | Legal Medicine | 3165 N Mcmullen Booth Rd, C1, Clearwater, FL 33761-2032 | 2006-12-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770184210 | Sandra Shanice Campisi | Behavior Technician | 29228 Us-19 N, Clearwater, FL 33761 | 2020-11-02 |
| 1659838449 | Branden Kleehammer | Occupational Therapy Assistant | 6941 300th Ave N, Clearwater, FL 33761 | 2019-02-27 |
| 1063901403 | Sheleaha C Egly I | Behavior Technician | 29288 Us Highway 19 N, Clearwater, FL 33761 | 2018-05-01 |
| 1760979629 | Melissa Irene Valentine | Social Worker | 6997 300th Ave North, Clearwater, FL 33761 | 2018-04-17 |
| 1871011049 | Maria's Adult Day Care Center | Clinic/Center | 26224 Us Highway 19 N., Clearwater, FL 33761 | 2017-09-07 |
| 1962933739 | Robert Hudson | Occupational Therapist | 3463 Northridge Dr, Clearwater, FL 33761 | 2017-03-23 |
| 1366985582 | Brandon Chad Brown | Physician Assistant | 29277 Hwy 19 North, Clearwater, FL 33761 | 2016-11-19 |
| 1730575606 | Layne S Winker | Physician Assistant | 26812 Us 19 N # 19, Clearwater, FL 33761 | 2015-04-08 |
| 1407254907 | M Christina Memoli Od Pa | Optometrist | 27901 Us 19 N, Clearwater, FL 33761 | 2014-12-15 |
| 1952729774 | Gina Pietras Spohn | Dermatology | 3165 N Mcmullen Booth Rd Bldg B, Clearwater, FL 33761 | 2014-03-29 |
| Find all providers in zip 33761 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578907184 | Aung Si Myint | Internal Medicine | 1831 N Belcher Rd Ste F1, Clearwater, FL 33765-1453 | 2013-04-25 |
| 1104012681 | Harborside Gastroenterology | Internal Medicine | 401 Corbett Street, Suite 350, Clearwater, FL 33756-7309 | 2007-09-19 |
| 1093872871 | Umesh Choudhry | Internal Medicine | 920 S Myrtle Ave, Suite A, Clearwater, FL 33756-3918 | 2007-01-02 |
| 1528122827 | Gastroenterology Consultants of Clearwater | Internal Medicine | 508 Jeffords Street Ste D, Clearwater, FL 33756 | 2006-12-20 |
| 1285717033 | Howard D Klein | Internal Medicine | 508 Jeffords Street, Suite D, Clearwater, FL 33756-3839 | 2006-10-23 |
| 1265492730 | Louis Aviles | Internal Medicine | 1007 Jeffords St, Suite 102, Clearwater, FL 33756-4023 | 2006-03-27 |
| 1003809419 | David Scott Borislow | Internal Medicine | 508 Jeffords St Ste D, Clearwater, FL 33756-3839 | 2005-08-31 |
| 1245440361 | Gourisankar Prasad Degala | Internal Medicine | 920 S Myrtle Ave, Suite A, Clearwater, FL 33756-3916 | 2007-05-24 |
| 1790802155 | Sarah Christine Manitsas | Internal Medicine | 1305 S Fort Harrison Ave, Suite E, Clearwater, FL 33756-3301 | 2007-03-23 |
| 1669597126 | Center for Digestive Healthcare, Inc. | Internal Medicine | 1260 S Martin Luther King Jr Ave, Suite E, Clearwater, FL 33756-4172 | 2007-03-20 |
| Find all providers in CLEARWATER | ||||
| City | CLEARWATER |
| Zip Code | 33761 |
Please comment or provide details below to improve the information on DIAGNOSTIC CLINIC MEDICAL GROUP INC.
| 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.