Active NPI
Richard Irvin Deibert, MD
- Family Medicine Physician
- Sarasota, FL
National Provider Identifier
1144509688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME109409
- Practice address
- 5955 Rand Blvd
Sarasota, FL 34238-5160 - Phone
- (941) 552-7508
- Fax
- (941) 552-7605
- NPI assigned
- Aug 16, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME109409 | FL | Primary |
Addresses
Primary practice location
5955 Rand Blvd
Sarasota, FL 34238-5160
Mailing address
5955 Rand Blvd
Sarasota, FL 34238-5160
Phone (941) 552-7508
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004622400 | Medicaid | FL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | kwyant@tidewell.org | Direct |
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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240126001007 | FL | Order and Referring Only - Family Practice | 6103086582 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME109409 | FL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558396800000",
"number": "1144509688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5955 RAND BLVD",
"city": "SARASOTA",
"state": "FL",
"postal_code": "342385160",
"telephone_number": "941-552-7508",
"fax_number": "941-552-7605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5955 RAND BLVD",
"city": "SARASOTA",
"state": "FL",
"postal_code": "342385160",
"telephone_number": "941-552-7508",
"fax_number": "941-552-7605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEIBERT",
"first_name": "RICHARD",
"middle_name": "IRVIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-16",
"last_updated": "2019-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME109409",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004622400",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "kwyant@tidewell.org",
"affiliation": "N",
"endpointDescription": "email address",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Medicaid Number",
"address_1": "5955 Rand Blvd",
"city": "Sarasota",
"state": "FL",
"country_code": "US",
"postal_code": "342385160",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}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 May 21, 2019; 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.