Baycare Outpatient Imaging LLC
Organization Active NPI Diagnostic Radiology Physician · Land O Lakes, FL
NPI 1164006359 · NPPES record last updated Jul 11, 2024
Key facts
- NPI
- 1164006359
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- BAYCARE OUTPATIENT IMAGING LLC
- Practice address
- 18600 Fernview St Ste 101
Land O Lakes, FL 34638-6212 - Phone
- (727) 281-9065
- NPI assigned
- May 12, 2021
- Organization subpart
- No
Authorized official
- Name
- Lynda Gorken
- Title
- VP Patient Financial Services
- Phone
- (727) 281-9202
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 8
Practitioners 46
-
Eric Alexander Addo, M.D.
-
Craig M. Banull, M. D.
-
Craig Bearison, MD
-
Lana Bellon, MD
-
Emmanuel Berchmans, M.D.
-
Timothy Alan Bonsack, M.D.
-
Sree Lalitha Degala, M.D.
-
Tracy Lee Halme, M.D.
-
Max Jacobson, MD
-
Soo Chon Kim, M.D.
-
Daniel S. Krop, M. D.
-
Rhonda K. McDowell, M. D.
-
Brian James Montague, M.D.
-
Gil Manuel Narvaez-Soto, M.D.
-
Kunal P Patel, M.D.
-
Sameet K. Rao, M.D.
-
Yair I Safriel, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2231922 | Baycare Outpatient Imaging LLC | Certificate of waiver | Aug 8, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190410002311 | FL | Part B Supplier - Clinic/Group Practice | 3577804087 |
Receives reassigned benefits from 177 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wesley Chapel, FL; Winter Haven, FL; Valrico, FL; Tampa, FL; Plant City, FL; Land O Lakes, FL |
National Provider Directory
- Tax ID family
- Baycare Outpatient Imaging LLC
Locations
18600 Fernview St
Ste 101
Land O Lakes, FL 34638
Phone (813) 692-8010
711 S Dale Mabry Hwy
Tampa, FL 33609
Phone (813) 259-1900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
18600 Fernview St Ste 101
Land O Lakes, FL 34638-6212
Mailing address
2995 Drew St FL 2
Clearwater, FL 33759-3012
Phone (727) 281-9065
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101818502 | Medicaid | FL |
Other providers in Land O Lakes, FL
- Shannon Barker
- Stephanie Anne Barnes
- Naomi Gean Barragan
- Brecken Yvette Bates
- Anamecia Francisca Baxley
- Baycare Urgent Care, LLC
- Baycare Urgent Care, LLC
- Makenna Bayyat
- Beach Health PLLC
- Jessica Beachkofsky
All providers in Land O Lakes, FL · Diagnostic Radiology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.