Individual provider Active NPI

Ewa A Bialikiewicz, M.D.

  • Family Medicine Physician
  • Port Charlotte, FL
National Provider Identifier
1114972312
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME139379 Issued in FL
Practice address
2450 Tamiami TRL Ste a
Port Charlotte, FL 33952-3922
Phone
(941) 624-2704
Fax
(941) 627-6066
NPI assigned
May 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01045564A IN
Family Medicine Physician 207Q00000X ME139379 FL Primary

Addresses

Primary practice location

2450 Tamiami TRL Ste a
Port Charlotte, FL 33952-3922

Mailing address

2450 Tamiami TRL Ste a
Port Charlotte, FL 33952-3922
Phone (941) 624-2704

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060913000527 IN Practitioner - Family PracticePractitioner - Obstetrics/Gynecology 2264436765 Reassigns benefits to 1 organization
I20190620002445 FL Practitioner - Family Practice 2264436765

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME139379FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Guidewell Sanitas I, LLC Family Medicine Current Accepting new patients
Privia Medical Group Indiana, LLC Current Accepting new patients
Privia Medical Group Indiana, LLC CurrentSince May 1, 2008 Accepting new patients
Privia Medical Group Indiana, LLC CurrentSince May 1, 2008 Accepting new patients
Saint Joseph Regional Medical Center, Inc. Family Medicine Past Accepting new patients

Locations

8400 NW 33rd St
Ste 201
Doral, FL 33122
Phone (786) 882-2869

303 S Nappanee St
Elkhart, IN 46514

410 Park Pl
#A
Mishawaka, IN 46545
Phone (574) 252-0667

410 Park Pl
Mishawaka, IN 46545
Phone (574) 252-0667

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1114972312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 TAMIAMI TRL STE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339523922",
            "telephone_number": "941-624-2704",
            "fax_number": "941-627-6066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 TAMIAMI TRL STE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339523922",
            "telephone_number": "941-624-2704",
            "fax_number": "941-627-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIALIKIEWICZ",
        "first_name": "EWA",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01045564A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME139379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.