DIAGNOSTIC CLINIC MEDICAL GROUP INC. (NPI# 1407851314) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407851314 |
| Entity Type | Organization |
| Organization Name | DIAGNOSTIC CLINIC MEDICAL GROUP INC. |
| Other Organization Name | DIAGNOSTIC CLINIC |
| 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 | 2005-06-16 |
| Last Update Date | 2020-08-26 |
| Authorized Official Name | GINA MARIE PREBECK (VP OF OPERATIONS) |
| Authorized Official Telephone | 7275818767 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207K00000X | Allergy & Immunology | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 207L00000X | Anesthesiology | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 207U00000X | Nuclear Medicine | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 207W00000X | Ophthalmology | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 207Y00000X | Otolaryngology | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 207ZC0500X |
Pathology Specialization: Cytopathology |
========= | FL | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | ========= | FL | Allopathic & Osteopathic Physicians |
| N | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
========= | FL | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | ========= | FL | Allopathic & Osteopathic Physicians |
| Y | 208800000X | Urology | ========= | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 260094304 | 05 | |
| FL | 260094300 | 05 |
| Other Name | Type Code |
|---|---|
| Diagnostic Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1154474245 | Diagnostic Clinic Medical Group Inc. | Clinical Medical Laboratory | 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 |
|---|---|---|---|---|
| 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 |
| 1316303308 | Optic Shoppe | Eyewear Supplier (Equipment, not the service) | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2016-01-07 |
| Find all providers in the same location | ||||
| 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 | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235363144 | Said Ismail Hakky | Urology | 8547 Merrimoor Blvd E, Largo, FL 33777-2145 | 2009-05-06 |
| 1780933127 | Kirk Dominic Cianciolo | Urology | 12464 Indian Rocks Rd, Largo, FL 33774 | 2012-08-30 |
| 1821257924 | William Wan Kao | Urology | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2008-06-03 |
| 1033383781 | Mohamed A Atalla | Urology | 1221 Mercantile Ln, Kaiser Permanente Department of Urology, Largo, MD 20774-5374 | 2008-04-14 |
| 1457545477 | Neil S. Kansal | Urology | 1221 Mercantile Ln, Kaiser Permanente Largo Medical Center, Largo, MD 20774-5374 | 2007-09-03 |
| 1861531170 | West Shore Urology Assoc | Urology | 13201 Walsingham Rd, Largo, FL 33774-3518 | 2007-02-05 |
| 1255391769 | Paul M Vazquez | Urology | 13201 Walsingham Rd, Largo, FL 33774-3518 | 2006-03-27 |
| 1669441705 | Jeffrey S Lombard | Urology | 2039 Indian Rocks Rd S, Largo, FL 33774-1035 | 2006-03-14 |
| 1154309813 | Madhu Priya P Khanna | Urology | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2006-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770193450 | Urotelemedicine LLC | Urology | 8669 Nw 36th St Ste 325, Doral, FL 33166-6698 | 2020-08-06 |
| 1700411618 | Ackerman Cancer Center, Pa | Urology | 159 North 3rd St, Macclenny, FL 32063-2103 | 2020-03-11 |
| 1043844483 | Jesse Aaron Ory | Urology | 5555 Ponce De Leon Blvd Fl 4, Coral Gables, FL 33146-2513 | 2020-02-25 |
| 1215591565 | Advent Health | Urology | 420 Celebration Ave, Celebration, FL 34747-4683 | 2019-04-23 |
| 1710442264 | Urologic Specialists of Central Florida Pllc | Urology | 575 S Wickham Rd Ste A, West Melbourne, FL 32904-1170 | 2019-02-08 |
| 1578028197 | Prody Urology, Pllc | Urology | 575 S Wickham Rd Ste B, West Melbourne, FL 32904-1170 | 2019-02-07 |
| 1366916843 | Dr. Carolyn Langford Urologic Solutions, LLC | Urology | 9400 Gladiolus Dr Ste 30, Fort Myers, FL 33908-9615 | 2019-01-17 |
| 1376016568 | Advanced Innovative Urology Pa | Urology | 4737 N Ocean Dr Ste 103, Lauderdale By The Sea, FL 33308-2920 | 2019-01-10 |
| 1306314281 | Urology Consultants of Boca Raton Pa | Urology | 825 Meadows Rd Ste 111, Boca Raton, FL 33486-2347 | 2018-11-08 |
| 1013490309 | Seetharam Bhat Kulthe Ramesh | Urology | 401 Celebration Pl Ste 200, Celebration, FL 34747-4971 | 2018-09-12 |
| Find all providers with the same taxonomy | ||||
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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.