Organization Active NPI

Digestive Disease Specialist of Manatee PL

  • Gastroenterology Physician
  • Bradenton, FL
National Provider Identifier
1174655211
Registry record updated Aug 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
ME85682 Issued in FL
Legal business name
DIGESTIVE DISEASE SPECIALIST OF MANATEE PL
Practice address
4502 Cortez Rd W Ste 204
Bradenton, FL 34210-3124
Phone
(941) 761-1800
NPI assigned
Mar 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2021

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

Authorized official

Name
Dr. Rimantas Zalepuga, M.D.NPI 1316977499
Title
Member
Phone
(941) 761-1800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X ME85682 FL Primary

Addresses

Primary practice location

4502 Cortez Rd W Ste 204
Bradenton, FL 34210-3124

Mailing address

PO Box 15089
Bradenton, FL 34280-5089
Phone (941) 761-1800

Other identifiers 5

IdentifierTypeStateIssuer
DC1249OtherFLRAIL ROAD MEDICARE
6102336OtherFLCIGNA
271367500MedicaidFL
74735OtherFLBCBS
9751349OtherFLGHI

Other names 1

  • DDSOM Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040628001253 FL Part B Supplier - Clinic/Group Practice 1951387158 Receives reassigned benefits from 6 practitioners
Practice locations: Bradenton, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1095975Digestive Disease Specialists of Manatee PL4502 Cortez Rd West Suite 204, Bradenton, FL 34210ComplianceApr 28, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

4502 Cortez Rd W
Ste 204
Bradenton, FL 34210
Phone (941) 761-1800

Practitioners & affiliated clinicians

Practitioners 6

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": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628640000000",
    "number": "1174655211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15089",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342805089",
            "telephone_number": "941-761-1800",
            "fax_number": "941-761-1883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 CORTEZ RD W STE 204",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342103124",
            "telephone_number": "941-761-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGESTIVE DISEASE SPECIALIST OF MANATEE PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A",
        "authorized_official_last_name": "ZALEPUGA",
        "authorized_official_first_name": "RIMANTAS",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "941-761-1800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME85682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DC1249",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6102336",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271367500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "74735",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "9751349",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DDSOM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DDSOM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.