NPIMap

Organization Active NPI

Diagnostic Clinic Medical Group Inc

  • Family Medicine Physician
  • Saint Petersburg, FL
National Provider Identifier
1124690433
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DIAGNOSTIC CLINIC MEDICAL GROUP INC
Practice address
6735 Crosswinds Dr N
Saint Petersburg, FL 33710-5471
Phone
(727) 548-8500
Fax
(727) 501-7328
NPI assigned
Jul 15, 2021
Organization subpart
Yes
Parent organization
DIAGNOSTIC CLINIC MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

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

Authorized official

Name
Gina Marie Prebeck
Title
VP of Operations
Phone
(727) 559-9461

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

6735 Crosswinds Dr N
Saint Petersburg, FL 33710-5471

Mailing address

6735 Crosswinds Dr N
Saint Petersburg, FL 33710-5471
Phone (727) 548-8500

Other identifiers 1

IdentifierTypeStateIssuer
00036OtherFLFLORIDA BLUE

Other names 1

  • Diagnostic Clinic Medical Group, Inc. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Diagnostic Clinci Med G12 organizations share this tax ID, including this one
Part of
Diagnostic Clinci Med G

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1124690433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6735 CROSSWINDS DR N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337105471",
            "telephone_number": "727-548-8500",
            "fax_number": "727-501-7328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6735 CROSSWINDS DR N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337105471",
            "telephone_number": "727-548-8500",
            "fax_number": "727-501-7328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC CLINIC MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIAGNOSTIC CLINIC MEDICAL GROUP INC",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "PREBECK",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "727-559-9461"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "00036",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diagnostic Clinic Medical Group, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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.