NPIMap

Organization Active NPI

Tampa Bay Surgical Group LLP

  • Surgery Physician
  • Tampa, FL
National Provider Identifier
1083085328
Registry record updated Oct 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
TAMPA BAY SURGICAL GROUP LLP
Practice address
606 S. Boulevard
Tampa, FL 33606-2630
Phone
(813) 254-3016
Fax
(813) 254-3019
NPI assigned
Oct 13, 2015
Organization subpart
Yes
Parent organization
TAMPA BAY SURGICAL GROUP LLPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2015

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

Authorized official

Name
John A Dietrick, MD
Title
President
Phone
(813) 254-3016

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

606 S. Boulevard
Tampa, FL 33606-2630

Mailing address

606 S. Boulevard
Tampa, FL 33606-2630
Phone (813) 254-3016

Other identifiers 1

IdentifierTypeStateIssuer
000210000MedicaidFL

National Provider Directory

National Provider Directory
Part of
Tampa Bay Surgical Group LLP

Locations

606 S Boulevard
Tampa, FL 33606
Phone (813) 254-3016

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444694400000",
    "number": "1083085328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 S. BOULEVARD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062630",
            "telephone_number": "813-254-3016",
            "fax_number": "813-254-3019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 S. BOULEVARD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062630",
            "telephone_number": "813-254-3016",
            "fax_number": "813-254-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAMPA BAY SURGICAL GROUP LLP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TAMPA BAY SURGICAL GROUP LLP",
        "enumeration_date": "2015-10-13",
        "last_updated": "2015-10-13",
        "status": "A",
        "authorized_official_last_name": "DIETRICK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-254-3016",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000210000",
            "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 Oct 13, 2015; 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.