NPIMap

Organization Active NPI

St Joseph'S Community Care Inc

  • Family Medicine Physician
  • Tampa, FL
National Provider Identifier
1003946591
Registry record updated Feb 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST JOSEPH'S COMMUNITY CARE INC
Practice address
3550 W Waters Ave Ste 110
Tampa, FL 33614-2767
Phone
(813) 886-8899
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2022

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

Authorized official

Name
Lynda Gorken
Title
VP
Phone
(727) 281-9202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3550 W Waters Ave Ste 110
Tampa, FL 33614-2767

Mailing address

3550 W Waters Ave Ste 110
Tampa, FL 33614-2767
Phone (813) 886-8899

Other identifiers 2

IdentifierTypeStateIssuer
372550201MedicaidFL
3725502-00MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040710000153 FL Part B Supplier - Clinic/Group Practice 8527046150 Receives reassigned benefits from 5 practitioners
Practice locations: Tampa, FL

National Provider Directory

National Provider Directory
Tax ID family
St Josephs Community Care4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2995 Drew St
Clearwater, FL 33759
Phone (727) 315-7496

1246 Ray Charles Blvd
Tampa, FL 33602
Phone (727) 753-7787

2550 W Mlk Blvd
Ste A
Tampa, FL 33607
Phone (813) 871-5437

11612 N Nebraska Ave
#A
Tampa, FL 33612
Phone (813) 977-5700

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1003946591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 W WATERS AVE STE 110",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336142767",
            "telephone_number": "813-886-8899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 W WATERS AVE STE 110",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336142767",
            "telephone_number": "813-886-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH'S COMMUNITY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "GORKEN",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "727-281-9202"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372550201",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3725502-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.