Individual provider Active NPI

Daniel Kalogeropoulos, PA-C

  • Physician Assistant
  • Bradenton, FL
National Provider Identifier
1114467669
Registry record updated May 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112183 Issued in FL
Practice address
8000 Sr 64 E
Bradenton, FL 34212
Phone
(941) 792-1404
Fax
(941) 795-1717
NPI assigned
Mar 2, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9112183 FL Primary

Addresses

Primary practice location

8000 Sr 64 E
Bradenton, FL 34212

Mailing address

8000 Sr 64 E
Bradenton, FL 34212
Phone (941) 792-1404

Other identifiers 1

IdentifierTypeStateIssuer
FBK5NOtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, FL2 enrollments
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171103001390 MA Practitioner - Physician Assistant 4880950096 Reassigns benefits to 1 organization
I20191011000457 FL Practitioner - Physician Assistant 4880950096 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Pain Management CurrentSince Sep 10, 2017 Accepting new patients
Coastal Orthopedics & Sports Medicine of Southwest Florida PA CurrentSince Aug 26, 2019 Accepting new patients
North Shore Anesthesia, LLC Past Accepting new patients

Locations

8000 State Road 64 E
Bradenton, FL 34212
Phone 94179214043315

6015 Pointe West Blvd
Bradenton, FL 34209
Phone (941) 782-0101

8340 Lakewood Ranch Blvd
Ste 300
Lakewood Ranch, FL 34202
Phone (941) 316-8200

900 Cummings Ctr
Ste 221U
Beverly, MA 01915
Phone (351) 400-6272

800 W Cummings Park
Ste 1200
Woburn, MA 01801
Phone (781) 330-0327

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1488412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1114467669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8000 SR 64 E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34212",
            "telephone_number": "941-792-1404",
            "fax_number": "941-795-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8000 SR 64 E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34212",
            "telephone_number": "941-792-1404",
            "fax_number": "941-795-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALOGEROPOULOS",
        "first_name": "DANIEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-02",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "FBK5N",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.