Active NPI
Phong Kim Phane, DMD
- Dentist
- St Petersburg, FL
National Provider Identifier
1124450283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN20248
- Practice address
- 3388 49TH St N
St Petersburg, FL 33710-2146 - Phone
- (727) 323-0377
- NPI assigned
- Jul 31, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN20248 | FL | Primary |
| Dentist | 122300000X | DRP1233 | FL |
Addresses
Primary practice location
3388 49TH St N
St Petersburg, FL 33710-2146
Mailing address
3388 49TH St N
St Petersburg, FL 33710-2146
Phone (727) 323-0377
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160215000902 | FL | Order and Referring Only - Dentist | 5092019893 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DRP1233 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cindy N. Brayer, DMD, PA | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Saint Petersburg, FL
- NPI 1184903775
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413763200000",
"number": "1124450283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3388 49TH ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337102146",
"telephone_number": "727-323-0377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3388 49TH ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337102146",
"telephone_number": "727-323-0377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHANE",
"first_name": "PHONG",
"middle_name": "KIM",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-07-31",
"last_updated": "2014-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN20248",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DRP1233",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.