NPIMap

Organization Active NPI

Diagnostic Clinic Medical Group Inc

  • Gastroenterology Physician
  • Clearwater, FL
National Provider Identifier
1124440912
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
DIAGNOSTIC CLINIC MEDICAL GROUP INC
Practice address
3165 N McMullen Booth Rd
Building B
Clearwater, FL 33761-2032
Phone
(727) 581-8767
Fax
(727) 581-8507
NPI assigned
Jan 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

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

Authorized official

Name
Gina M Prebeck
Title
VP of Operations
Phone
(727) 581-8767

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

3165 N McMullen Booth Rd
Building B
Clearwater, FL 33761-2032

Mailing address

3165 N McMullen Booth Rd
Building B
Clearwater, FL 33761-2032
Phone (727) 581-8767

National Provider Directory

National Provider Directory

Locations

1465 S Fort Harrison Ave
Ste 204
Clearwater, FL 33756
Phone (727) 443-4502

1601 West Bay Dr
Largo, FL 33770
Phone (727) 581-8229

168 14th St SW
Largo, FL 33770
Phone (727) 581-8229

3820 Tampa Rd
Ste 100
Palm Harbor, FL 34684
Phone (727) 785-6422

630 Pasadena Ave S
St Petersburg, FL 33707
Phone (727) 345-7100

6735 Crosswinds Dr N
St Petersburg, FL 33710
Phone (727) 548-8500

12210 Bruce B Downs Blvd
Tampa, FL 33612
Phone (813) 971-2050

12725N DL Mabry Hwy
Tampa, FL 33618
Phone (727) 581-8767

385 Cypress Gardens Blvd
Winter Haven, FL 33880
Phone (863) 291-0140

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1389571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1124440912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3165 N MCMULLEN BOOTH RD",
            "address_2": "BUILDING B",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337612032",
            "telephone_number": "727-581-8767",
            "fax_number": "727-581-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3165 N MCMULLEN BOOTH RD",
            "address_2": "BUILDING B",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337612032",
            "telephone_number": "727-581-8767",
            "fax_number": "727-581-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC CLINIC MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-13",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A",
        "authorized_official_last_name": "PREBECK",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "727-581-8767"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.