NPIMap

Organization Active NPI

Timothy C. Runyon, D.P.M. P.a.

  • Non-Pharmacy Dispensing Site
  • St Petersburg, FL
National Provider Identifier
1093869851
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
TIMOTHY C. RUNYON, D.P.M. P.A.
Practice address
1401 16TH St N
St. Petersburg, FL 33704-4123
Phone
(727) 894-0794
Fax
(727) 895-1215
NPI assigned
Jan 22, 2007
Last updated
Oct 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Authorized official

Name
Dr. Kyle C Kinmon, DPM
Title
Provider/Owner
Phone
(561) 995-0229

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X PO1101 FL
Customized Equipment (DME) 332BC3200X PO1101 FL
Radiology Podiatrist 213ER0200X PO1101 FL
Sports Medicine Podiatrist 213ES0000X PO1101 FL
Foot & Ankle Surgery Podiatrist 213ES0103X PO1101 FL
Non-Pharmacy Dispensing Site 332900000X NU Primary

Addresses

Primary practice location

1401 16TH St N
St. Petersburg, FL 33704-4123

Mailing address

1401 16TH St N
St. Petersburg, FL 33704-4123
Phone (727) 894-0794

Other identifiers 1

IdentifierTypeStateIssuer
340415300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031117000143 FL Part B Supplier - Clinic/Group Practice 4486568250 Receives reassigned benefits from 20 practitioners
Practice locations: Brandon, FL; Cape Coral, FL; Fort Myers, FL; Palm Harbor, FL; St Petersburg, FL; Tampa, FL
O20100930035012 FL DME Supplier - Physician - Podiatry 4486568250 Practice locations: Saint Petersburg, FL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

669A W Lumsden Rd
Brandon, FL 33511
Phone (813) 654-3354

2595 Tampa Rd
Ste O
Palm Harbor, FL 34684
Phone (727) 785-5611

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1093869851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 16TH ST N",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "337044123",
            "telephone_number": "727-894-0794",
            "fax_number": "727-895-1215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 16TH ST N",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "337044123",
            "telephone_number": "727-894-0794",
            "fax_number": "727-895-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY C. RUNYON, D.P.M. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "KINMON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "561-995-0229",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "PO1101",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "FL",
            "license": "PO1101",
            "primary": false
        },
        {
            "code": "213ER0200X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Radiology",
            "state": "FL",
            "license": "PO1101",
            "primary": false
        },
        {
            "code": "213ES0000X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Sports Medicine",
            "state": "FL",
            "license": "PO1101",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO1101",
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340415300",
            "state": "FL"
        }
    ],
    "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 Oct 9, 2024; 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.