Active NPI
Jake Evan Lewis, MD
- Vascular & Interventional Radiology Physician
- Tampa, FL
National Provider Identifier
1255082095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular & Interventional Radiology Physician
- License
- ME175901
- Practice address
- 17 Davis Blvd
Tampa, FL 33606-3475 - Phone
- (813) 250-2506
- NPI assigned
- Jan 13, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | ME175901 | FL | Primary |
Addresses
Primary practice location
17 Davis Blvd
Tampa, FL 33606-3475
Mailing address
6107 Heroncrest CT
Lithia, FL 33547-3878
Phone (208) 573-7653
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240723001183 | CO | Order and Referring Only - General Surgery | 6103362462 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME175901 | FL | MD | Vascular & Interventional Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769212800000",
"number": "1255082095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6107 HERONCREST CT",
"city": "LITHIA",
"state": "FL",
"postal_code": "335473878",
"telephone_number": "208-573-7653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 DAVIS BLVD",
"city": "TAMPA",
"state": "FL",
"postal_code": "336063475",
"telephone_number": "813-250-2506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "JAKE",
"middle_name": "EVAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-01-13",
"last_updated": "2026-01-24",
"certification_date": "2026-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0204X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "FL",
"license": "ME175901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.