Baycare Outpatient Imaging LLC
Organization Active NPI Diagnostic Radiology Physician · Wesley Chapel, FL
NPI 1235898529 · NPPES record last updated May 24, 2024
Key facts
- NPI
- 1235898529
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- BAYCARE OUTPATIENT IMAGING LLC
- Practice address
- 4503 Bruce B. Downs Blvld.
Suite 104
Wesley Chapel, FL 33544 - Phone
- (813) 586-8500
- NPI assigned
- Dec 14, 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 20
-
Brian L. Anderson, M. D.
-
Regina Ason, MD
-
Richard Ghavami, M. D.
-
Husam Habboub, M. D.
-
Robert R. Harriage, M. D.
-
Thomas Kirchner, M.D.
-
John S Miliziano, MD
-
Evan Stone, M.D.
-
Idelisa Torres-Berastain, M.D.
-
Zia Khan, DO
-
Hasti Larjani, MD
-
Irfan Mamoun, M.D.
-
Bradley Matthew White, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2272035 | Baycare Outpatient Imaging, LLC | Certificate of waiver | Nov 13, 2026 |
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
4503 Bruce B Downs Blvd
Wesley Chapel, FL 33544
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
4503 Bruce B. Downs Blvld.
Suite 104
Wesley Chapel, FL 33544
Mailing address
2995 Drew St FL 2
Clearwater, FL 33759-3012
Phone (727) 281-9065
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101818503 | Medicaid | FL |
Other names
- BOI WESLEY CHAPEL
Other providers in Wesley Chapel, FL
- Bay Area Consulting Telemed LLC
- Bay Area Fitness and Physical Therapy, LLC
- Bay Area Medical Equipements LLC
- Baycare Medical Group Inc
- Baycare Medical Group Inc
- Baycare Pasco, Inc.
- Baycare Pasco, Inc.
- David Anthony Beach
- Kimberly Beagle
- Stefani Rohani Marie Beale
All providers in Wesley Chapel, 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 May 24, 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.