NPIMap

Organization Active NPI

Diagnostic Clinic Medical Group, PA

  • Physical Therapist
  • Largo, FL
National Provider Identifier
1073517090
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 15206 Issued in FL
Legal business name
DIAGNOSTIC CLINIC MEDICAL GROUP, PA
Practice address
1551 W Bay Dr
Rehabilitation Department
Largo, FL 33770-2209
Phone
(727) 531-8767
NPI assigned
Jun 8, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

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

Authorized official

Name
Michael A.M. Bosman, P.T.
Title
Consultant
Phone
(727) 581-8767

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X SW7076 FL
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT 15206 FL Primary

Addresses

Primary practice location

1551 W Bay Dr
Rehabilitation Department
Largo, FL 33770-2209

Mailing address

1551 West Bay Drive
Attn: Kelly Gregg
Largo, FL 33770-6805
Phone (727) 531-8767

Other names 1

  • MedFit Rehabilitation and Wellness Providers of Pinellas, Inc. Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Diagnostic Clinci Med G12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1073517090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 WEST BAY DRIVE",
            "address_2": "ATTN: KELLY GREGG",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337706805",
            "telephone_number": "727-531-8767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 W BAY DR",
            "address_2": "REHABILITATION DEPARTMENT",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337702209",
            "telephone_number": "727-531-8767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC CLINIC MEDICAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A",
        "authorized_official_last_name": "BOSMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A.M.",
        "authorized_official_title_or_position": "CONSULTANT",
        "authorized_official_telephone_number": "727-581-8767",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "FL",
            "license": "SW7076",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 15206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedFit Rehabilitation and Wellness Providers of Pinellas, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "MedFit Rehabilitation and Wellness Providers of Pinellas, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Largo, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; 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.