Individual provider Active NPI

Gayathri H Subbaraya, DMD

  • General Practice Dentistry
  • Lakeland, FL
National Provider Identifier
1003258427
Registry record updated Jul 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN20309 Issued in FL
Practice address
2960 Lakeland Highlands Rd
Lakeland, FL 33803-4370
Phone
(863) 665-1545
Fax
(863) 665-1615
NPI assigned
Jul 26, 2013
Last updated
Jul 26, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN20309 FL Primary

Addresses

Primary practice location

2960 Lakeland Highlands Rd
Lakeland, FL 33803-4370

Mailing address

2960 Lakeland Highlands Rd
Lakeland, FL 33803-4370
Phone (863) 665-1545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170307002585 FL Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 1355625534

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Coast Florida P.a. PastSince Jun 22, 2021 Accepting new patients
Coast Florida P.a. Past Accepting new patients

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374796800000",
    "number": "1003258427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 LAKELAND HIGHLANDS RD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034370",
            "telephone_number": "863-665-1545",
            "fax_number": "863-665-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 LAKELAND HIGHLANDS RD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034370",
            "telephone_number": "863-665-1545",
            "fax_number": "863-665-1615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUBBARAYA",
        "first_name": "GAYATHRI",
        "middle_name": "H",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-26",
        "last_updated": "2013-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN20309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.