NPIMap

Individual provider Active NPI

Wahid Tazudeen, M.D.

  • Neurology Physician
  • Tampa, FL
National Provider Identifier
1104008606
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036131939 Issued in IL
Practice address
2816 W Virginia Ave
Tampa, FL 33607-6330
Phone
(813) 876-6321
Fax
(813) 870-0350
NPI assigned
Nov 27, 2007
Last updated
Nov 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 57013812 OH
Neurology Physician 2084N0400X 036131939 IL Primary
Neurology Physician 2084N0400X 01071600A IN
Neurology Physician 2084N0400X ME150399 FL

Addresses

Primary practice location

2816 W Virginia Ave
Tampa, FL 33607-6330

Mailing address

2816 W Virginia Ave
Tampa, FL 33607-6330
Phone (813) 876-6321

Other identifiers 2

IdentifierTypeStateIssuer
150640003OtherINMEDICARE
201120900MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140801001943 IL Practitioner - Neurology 5698927341 Reassigns benefits to 2 organizations
I20211007001344 FL Practitioner - Neurology 5698927341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Drexel University College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gibson Community Hospital AssociationGroup PAC ID 5092703124, shared by 16 NPIs, 159 clinicians

Practice addresses (Care Compare)

1 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-4297

1120 N Melvin St
Gibson City, IL 60936-1477

227 N Market St
Paxton, IL 60957-1123
Phone (217) 379-4864

3 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-4030

4 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-4251

422 W White St
Clinton, IL 61727-2272
Phone (217) 935-9571

7 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-5500

806 E Walnut St
Watseka, IL 60970-1584
Phone (815) 432-1078

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME150399FLMDNeurology Physician
036131939ILMDNeurology Physician
01071600AINMDNeurology Physician
57013812OHMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association Current Accepting new patients
Gibson Community Hospital Association CurrentSince Jul 22, 2022 Accepting new patients
Gibson Community Hospital Association CurrentSince Jul 22, 2022 Accepting new patients
Neurological Specialties Neurology PA Neurology CurrentSince Nov 1, 2021 Accepting new patients
Neurology Clinic of Danville, LLC PastSince Aug 1, 2003 Accepting new patients
Neurological Specialties Neurosurgery PA PastSince Nov 1, 2021 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

2816 W Virginia Ave
Tampa, FL 33607
Phone (813) 876-6321

701 W Fairchild St
Danville, IL 61832
Phone (217) 431-1100

701 W Fairchild St
Ste C
Danville, IL 61832
Phone (217) 431-8400

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

4 Doctors Park
Gibson City, IL 60936
Phone (217) 784-4540

7 Doctors Park
Gibson City, IL 60936
Phone (217) 784-5500

Interoperability endpoints

  • Direct secure messaging: wahid.tazudeen.p44@direct.gapho.nextgenshare.com
  • Direct secure messaging: wahid.tazudeen.p52@direct.gapho.nextgenshare.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1104008606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2816 W VIRGINIA AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076330",
            "telephone_number": "813-876-6321",
            "fax_number": "813-870-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2816 W VIRGINIA AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076330",
            "telephone_number": "813-876-6321",
            "fax_number": "813-870-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAZUDEEN",
        "first_name": "WAHID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-27",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "57013812",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036131939",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "01071600A",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME150399",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "150640003",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201120900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.