Promedtc, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PROMEDTC, LLC

Practice address

3109 Lithia Pinecrest Rd
Valrico, FL 33596-5632

Phone

(718) 666-8759

NPI assigned

Jun 10, 2020

Organization subpart

No

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

Authorized official

Name

Tymur Chepi-Ipa, APRN-CNPI 1548623432

Title

Medical Director

Phone

(718) 666-8759

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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

• Tymur Chepi-Ipa

  • Nurse Practitioner
  • Tampa, FL
  • NPI 1548623432
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591747200000",
    "number": "1104441617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 N ASHLEY DR UNIT 1815",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336024373",
            "telephone_number": "718-666-8759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 LITHIA PINECREST RD",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335965632",
            "telephone_number": "718-666-8759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDTC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-10",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A",
        "authorized_official_last_name": "CHEPI-IPA",
        "authorized_official_first_name": "TYMUR",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "718-666-8759",
        "authorized_official_credential": "APRN-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1548623432",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "aprima",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "aprima",
            "address_1": "3109 Lithia Pinecrest Rd",
            "city": "Valrico",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335965632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Primary Care Clinic/Center in Valrico, FL
• Providers in Valrico, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.