NPIMap

Organization Active NPI

DRS Clack Spencer White & McCormack PA

Doing business as Sarasota Pathology

  • Clinical Medical Laboratory
  • Sarasota, FL
National Provider Identifier
1124354410
Registry record updated Mar 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
LAB800000813 Issued in FL
Legal business name
DRS CLACK SPENCER WHITE & MCCORMACK PA
Doing business as
Sarasota Pathology
Practice address
2001 Webber St
Sarasota, FL 34239-5237
Phone
(941) 362-8900
Fax
(941) 362-8987
NPI assigned
Oct 22, 2009
Organization subpart
Yes
Parent organization
DRS CLACK SPENCER WHITE & MCCORMACK PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2017

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

Authorized official

Name
Kevin M McCormack, M.D., PHD
Title
President
Phone
(941) 362-8900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X LAB800000813 FL Primary

Addresses

Primary practice location

2001 Webber St
Sarasota, FL 34239-5237

Mailing address

2001 Webber St
Sarasota, FL 34239-5237
Phone (941) 362-8900

Other identifiers 3

IdentifierTypeStateIssuer
L8218OtherFLBCBS OF FLORIDA
LAB 80000813OtherFLAHCA CLINICAL LABORATORY LICENSE
10D0296120OtherFLCMS CLIA CERTIFICATION

Other names 1

  • Sarasota Pathology Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041216000883 FL Part B Supplier - Clinic/Group Practice 2860459211 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Apollo Beach, FL; North Venice, FL; Saint Petersburg, FL; Sarasota, FL
O20110214000146 FL Part B Supplier - Independent Clinical Laboratory 2860459211 Practice locations: Sarasota, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0296120DRS Clack Spencer White & McCormack PA D/B/a2001 Webber St, Sarasota, FL 34239AccreditationFeb 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Sarasota Prof Serv2 organizations share this tax ID, including this one
Part of
Sarasota Prof Serv

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5940 Frond Way
Apollo Beach, FL 33572
Phone (941) 362-8900

2001 Webber St
Sarasota, FL 34239
Phone (941) 362-8900

2001 Webber St
Fl 2
Sarasota, FL 34239
Phone (941) 362-8900

2001 Webber St
Fl Second
Sarasota, FL 34239

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490572800000",
    "number": "1124354410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 WEBBER ST",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342395237",
            "telephone_number": "941-362-8900",
            "fax_number": "941-362-8987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 WEBBER ST",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342395237",
            "telephone_number": "941-362-8900",
            "fax_number": "941-362-8987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS CLACK SPENCER WHITE & MCCORMACK PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DRS CLACK SPENCER WHITE & MCCORMACK PA",
        "enumeration_date": "2009-10-22",
        "last_updated": "2017-03-27",
        "status": "A",
        "authorized_official_last_name": "MCCORMACK",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-362-8900",
        "authorized_official_credential": "M.D., PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "LAB800000813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "L8218",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA CLINICAL LABORATORY LICENSE",
            "identifier": "LAB 80000813",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS CLIA CERTIFICATION",
            "identifier": "10D0296120",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sarasota Pathology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sarasota, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.