Individual provider Active NPI

Eva M Grant, D.O.

  • Family Medicine Physician
  • Tampa, FL
National Provider Identifier
1275817512
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02004277A Issued in IN
Practice address
602 S Howard Ave
Tampa, FL 33606-2413
Phone
(813) 253-2113
Fax
(907) 377-1969
NPI assigned
Oct 5, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X OS16087 FL
Family Medicine Physician 207Q00000X 02004277A IN Primary

Addresses

Primary practice location

602 S Howard Ave
Tampa, FL 33606-2413

Mailing address

602 S Howard Ave
Tampa, FL 33606-2413
Phone (813) 253-2113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200121001326 FL Practitioner - Family Practice 4688996366 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS16087FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Tampa After Hours Clinic, LLC Single Specialty CurrentSince Nov 8, 2019 Accepting new patients

Locations

602 S Howard Ave
Tampa, FL 33606
Phone (813) 253-2113

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1275817512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 S HOWARD AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062413",
            "telephone_number": "813-253-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 S HOWARD AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062413",
            "telephone_number": "813-253-2113",
            "fax_number": "907-377-1969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "EVA",
        "middle_name": "M",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-05",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS16087",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02004277A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.