Organization Active NPI

Verimed Health Group Pinellas Park, LLC

  • Internal Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1043441546
Registry record updated Jan 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS8908 Issued in FL
Legal business name
VERIMED HEALTH GROUP PINELLAS PARK, LLC
Practice address
12450 Roosevelt Blvd N Ste 308
St Petersburg, FL 33716-1902
Phone
(727) 577-0285
Fax
(727) 577-3870
NPI assigned
Jul 31, 2009
Last updated
Jan 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2023

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

Authorized official

Name
Julissa Ortiz
Title
Assistant Administrator
Phone
(727) 577-0285

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS8908 FL Primary

Addresses

Primary practice location

12450 Roosevelt Blvd N Ste 308
St Petersburg, FL 33716-1902

Mailing address

12450 Roosevelt Blvd N
St Petersburg, FL 33716-1902
Phone (727) 577-0285

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100928001344 FL Part B Supplier - Clinic/Group Practice 4688790546 Receives reassigned benefits from 3 practitioners
Practice locations: St Petersburg, FL

National Provider Directory

National Provider Directory

Locations

2030 E Speedway Blvd
Ste 118
Tucson, AZ 85719
Phone (520) 268-4609

9365 US Highway 19 N
Ste E
Pinellas Park, FL 33782
Phone (727) 577-0285

12450 Roosevelt Blvd N
St Petersburg, FL 33716
Phone (727) 571-1688

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1248998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674345600000",
    "number": "1043441546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12450 ROOSEVELT BLVD N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337161902",
            "telephone_number": "727-577-0285",
            "fax_number": "727-577-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12450 ROOSEVELT BLVD N STE 308",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337161902",
            "telephone_number": "727-577-0285",
            "fax_number": "727-577-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERIMED HEALTH GROUP PINELLAS PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-31",
        "last_updated": "2023-01-22",
        "certification_date": "2023-01-22",
        "status": "A",
        "authorized_official_last_name": "ORTIZ",
        "authorized_official_first_name": "JULISSA",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "727-577-0285"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS8908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2023; 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.