Individual provider Active NPI

Alfonso Campos, MD

  • Pediatrics Physician
  • Tampa, FL
National Provider Identifier
1285641076
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME40853 Issued in FL
Practice address
12901 Bruce B Downs Blvd
Tampa, FL 33612-4742
Phone
(813) 259-8760
Fax
(813) 259-8765
NPI assigned
Aug 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME40853 FL Primary

Addresses

Primary practice location

12901 Bruce B Downs Blvd
Tampa, FL 33612-4742

Mailing address

PO Box 917770
Orlando, FL 32891-0001
Phone (813) 974-2201

Other identifiers 2

IdentifierTypeStateIssuer
067774400MedicaidFL
30525OtherFLBLUE CROSS BLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address acampos7957@direct.tgh.org

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
I20100505000144 FL Practitioner - Pediatric Medicine 5294765970 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME40853FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa General Hospital Current Accepting new patients
University Medical Service Association Inc Current Accepting new patients

Locations

12901 Bruce B Downs Blvd
#62
Tampa, FL 33612

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: acampos7957@direct.tgh.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 2

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": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1285641076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328910001",
            "telephone_number": "813-974-2201",
            "fax_number": "813-974-4325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12901 BRUCE B DOWNS BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336124742",
            "telephone_number": "813-259-8760",
            "fax_number": "813-259-8765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPOS",
        "first_name": "ALFONSO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME40853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067774400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "30525",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "acampos7957@direct.tgh.org",
            "affiliation": "N",
            "address_1": "12901 Bruce B Downs Blvd",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336124742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.