Octavio Andres Tobar

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT003335 Issued in GA

Practice address

1950 Barrett Lakes Blvd NW Apt 1213
Kennesaw, GA 30144

Phone

(813) 447-0124

NPI assigned

Jul 19, 2017

Reactivated

Jul 31, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: otobar112355@direct.tgh.org
• FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

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.

• Tampa General Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1124558929
  NPD

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

{
    "created_epoch": "1500422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534723200000",
    "number": "1033632203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 BARRETT LAKES BLVD NW APT 1213",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301447535",
            "telephone_number": "813-447-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 BARRETT LAKES BLVD NW APT 1213",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30144",
            "telephone_number": "813-447-0124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3300 W Camelback Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850173030",
            "country_code": "US",
            "telephone_number": "480-431-1822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOBAR",
        "first_name": "OCTAVIO",
        "middle_name": "ANDRES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-19",
        "last_updated": "2018-08-20",
        "deactivation_date": "2017-12-05",
        "reactivation_date": "2018-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL4196",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT003335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECRETARY OF STATE",
            "identifier": "AT003335",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "AL4196",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanessa Lauren Tiger, MPT
• Jennifer Cummings Tillery, LPC, NCC
• Sharika Tillman, FNP -BC
• Tiara Timothy
• Justin Michael Tinsley, DC
• Todd Supnick DC PC
• Jerry Tee Todd, M.D.
• Laura Todd, LPN
• Tyanne Jahnae Topps
• Craig Torell, M.A., M.DIV., LPC

• Athletic Trainer in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.