Individual provider Active NPI

Manuel Jose Ruiz, MD

  • Internal Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1144590720
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME117478 Issued in FL
Practice address
10051 5TH St N Ste 200
St Petersburg, FL 33702-2211
Phone
(727) 824-0780
Fax
(813) 514-8891
NPI assigned
Jan 12, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME117478 FL Primary

Addresses

Primary practice location

10051 5TH St N Ste 200
St Petersburg, FL 33702-2211

Mailing address

10051 5TH St N Ste 200
Saint Petersburg, FL 33702-2211
Phone (727) 824-0780

Other identifiers 1

IdentifierTypeStateIssuer
009612000MedicaidFL

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131010002017 FL Practitioner - Internal Medicine 5294969929 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optumcare Florida, LLCGroup PAC ID 3072403476, 266 clinicians

Practice addresses (Care Compare)

1460 Beltrees St
Suite 1
Dunedin, FL 34698-8353
Phone (727) 736-5120

Hospital & facility affiliations

  • HCA Florida Largo Hospital Hospital, Largo, FL, CCN 100248

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare Florida LLC Internal Medicine CurrentSince Sep 23, 2013 Accepting new patients
Optumcare Florida, LLC CurrentSince Sep 23, 2013 Accepting new patients
Optumcare Florida Ci, LLC Past Accepting new patients

Locations

1460 Beltrees St
Ste 1
Dunedin, FL 34698
Phone (727) 736-5120

1345 West Bay Dr
Ste 202
Largo, FL 33770
Phone (727) 559-0895

10051 5th St N
Ste 200
St Petersburg, FL 33702
Phone (727) 286-4093

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1144590720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10051 5TH ST N STE 200",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337022211",
            "telephone_number": "727-824-0780",
            "fax_number": "813-514-8891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10051 5TH ST N STE 200",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337022211",
            "telephone_number": "727-824-0780",
            "fax_number": "813-514-8891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUIZ",
        "first_name": "MANUEL",
        "middle_name": "JOSE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-12",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME117478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009612000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.