Individual provider Active NPI

Sergio L Selva, M.D.

  • Diagnostic Radiology Physician
  • Venice, FL
National Provider Identifier
1023055472
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME0070607 Issued in FL
Practice address
512 Nokomis Ave S
Venice, FL 34285-2817
Phone
(941) 488-7781
Fax
(941) 484-9235
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X ME0070607 FL Primary
Vascular & Interventional Radiology Physician 2085R0204X ME0070607 FL

Addresses

Primary practice location

512 Nokomis Ave S
Venice, FL 34285-2817

Mailing address

PO Box 1508
Venice, FL 34284-1508
Phone (941) 488-7781

Other identifiers 1

IdentifierTypeStateIssuer
254798800MedicaidFL

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100708000275 FL Practitioner - Diagnostic RadiologyPractitioner - Nuclear MedicinePractitioner - Interventional Radiology 2365573391 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology, Nuclear Medicine
Education
University of South Florida College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Associates of Venice and Englewood PAGroup PAC ID 8729039292, 9 clinicians

Practice addresses (Care Compare)

512 - 516 S Nokomis
Venice, FL 34285-3022
Phone (941) 486-3483

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0070607FLMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Radiology Partners LTD Diagnostic Radiology CurrentSince May 1, 2023 Accepting new patients
Tallahassee Diag Imaging Ctr LTD Diagnostic Radiology CurrentSince May 1, 2023 Accepting new patients
Radiology Associates of Venice and Englewood PA Diagnostic Radiology CurrentSince Jul 6, 1998 Accepting new patients
Radiology Associates of Tallahassee PA Diagnostic Radiology CurrentSince May 1, 2023 Accepting new patients

Locations

900 Pine St
Englewood, FL 34223
Phone (941) 474-5093

1600 Phillips Rd
Tallahassee, FL 32308
Phone (850) 216-3686

1300 Miccosukee Rd
Tallahassee, FL 32308
Phone (850) 431-1155

512 Nokomis Ave S
Venice, FL 34285
Phone (941) 486-3483

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1023055472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1508",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342841508",
            "telephone_number": "941-488-7781",
            "fax_number": "941-484-9235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 NOKOMIS AVE S",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342852817",
            "telephone_number": "941-488-7781",
            "fax_number": "941-484-9235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELVA",
        "first_name": "SERGIO",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME0070607",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": "ME0070607",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254798800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, FL

Sources for this page

Verify at the official NPI Registry.