DIAGNOSTIC CLINIC MEDICAL GROUP INC. (NPI# 1154474245) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1154474245 |
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 | 2007-01-19 |
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 | 291U00000X | Clinical Medical Laboratory | 10D2079095 | FL | Laboratories |
State | Issuer | Identifier | Type Code |
---|---|---|---|
FL | MEDICARE LAB ID# | L8189 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407851314 | Diagnostic Clinic Medical Group Inc. | Allergy & Immunology | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2005-06-16 |
1124425947 | Diagnostic Clinic Medical Group Inc. | Family Medicine | 6776 54th Ave N, Suite A, St Petersburg, FL 33709-1405 | 2014-11-21 |
1780080945 | Diagnostic Clinic Medical Group Inc. | Family Medicine | 630 Pasadena Ave S, St Petersburg, FL 33707-2128 | 2014-11-14 |
1699927616 | Diagnostic Clinic Medical Group Inc. | Durable Medical Equipment & Medical Supplies | 3131 N Mcmullen Booth Rd, Clearwater, FL 33761-2008 | 2008-10-22 |
1942452966 | Diagnostic Clinic Medical Group Inc. | Ophthalmology | 3820 Tampa Rd, Suite 101, Palm Harbor, FL 34684-3609 | 2008-10-22 |
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 | 291U00000X |
Grouping | Laboratories |
Classification | Clinical Medical Laboratory |
(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
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1831195379 | Largo Surgery LLC | Clinical Medical Laboratory | 1401 W Bay Dr, Largo, FL 33770-2207 | 2005-06-21 |
1336499516 | Healthlink Diagnostic Laboratories, Inc. | Clinical Medical Laboratory | 13191 Starkey Rd, Ste 15, Largo, FL 33773-1400 | 2012-09-14 |
1275774127 | Baycare Ambulatory Services | Clinical Medical Laboratory | 8452 118th Ave, Largo, FL 33773-5007 | 2009-03-23 |
1013057090 | Suncoast Internal Medicine Consultants | Clinical Medical Laboratory | 13644 Walsingham Rd, Largo, FL 33774-3532 | 2007-02-07 |
1912072851 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Clinical Medical Laboratory | 1221 Mercantile Lane, Largo, MD 20774-5374 | 2006-11-22 |
1275641417 | Ultrasound Services of America, Inc | Clinical Medical Laboratory | 1400 Mercantile Ln, Suite 240b, Largo, MD 20774-5341 | 2006-08-28 |
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1033718333 | Jmj Labs LLC Dba Arcpoint Labs of Saint Petersburg | Clinical Medical Laboratory | 4713 66th St N, Kenneth City, FL 33709-3113 | 2020-10-19 |
1134728405 | Biolabs Diagnostics LLC | Clinical Medical Laboratory | 7865 Sw Ellipse Way, Stuart, FL 34997-7247 | 2020-10-19 |
1013516319 | Axe Analytics, LLC | Clinical Medical Laboratory | 917 Se Lincoln Ave Ste B, Stuart, FL 34994-3810 | 2020-10-19 |
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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.