Active NPI
Fanourios Iacovos Ferderigos, M.D.
- Orthopaedic Surgery Physician
- Palm Harbor, FL
National Provider Identifier
1235120122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- ME40703
- Practice address
- 2626 Tampa Rd
Suite 103
Palm Harbor, FL 34684-3155 - Phone
- (727) 789-3300
- Fax
- (727) 787-3454
- NPI assigned
- Oct 31, 2005
- 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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | ME40703 | FL | Primary |
Addresses
Primary practice location
2626 Tampa Rd
Suite 103
Palm Harbor, FL 34684-3155
Mailing address
2626 Tampa Rd
Suite 103
Palm Harbor, FL 34684-3155
Phone (727) 789-3300
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02051 | Other | FL | WELLCARE PROVIDER NUMBER |
| 15800Z | Other | FL | MEDICARE PTAN |
| 220139000 | Other | FL | FEDERAL WORKERS COMP PROV |
| 207845 | Other | FL | AVMED PROVIDER NUMBER |
| 592745575001 | Other | FL | CHAMPUS PROVIDER NUMBER |
| 1573201020 | Other | FL | CIGNA PROVIDER NUMBER |
| 624281 | Other | FL | AETNA HMO |
| 10015687 | Other | FL | RAILROAD MEDICARE |
| 4133544 | Other | FL | AETNA PPO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME40703 | FL | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434067200000",
"number": "1235120122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2626 TAMPA RD",
"address_2": "SUITE 103",
"city": "PALM HARBOR",
"state": "FL",
"postal_code": "346843155",
"telephone_number": "727-789-3300",
"fax_number": "727-787-3454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2626 TAMPA RD",
"address_2": "SUITE 103",
"city": "PALM HARBOR",
"state": "FL",
"postal_code": "346843155",
"telephone_number": "727-789-3300",
"fax_number": "727-787-3454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERDERIGOS",
"first_name": "FANOURIOS",
"middle_name": "IACOVOS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-31",
"last_updated": "2015-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "FL",
"license": "ME40703",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE PROVIDER NUMBER",
"identifier": "02051",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "15800Z",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL WORKERS COMP PROV",
"identifier": "220139000",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVMED PROVIDER NUMBER",
"identifier": "207845",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS PROVIDER NUMBER",
"identifier": "592745575001",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PROVIDER NUMBER",
"identifier": "1573201020",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "624281",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "10015687",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "4133544",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palm Harbor, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.