Individual provider Active NPI

David John Niles, DO

  • Emergency Medicine Physician
  • Tampa, FL
National Provider Identifier
1295777340
Registry record updated Aug 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OS5288 Issued in FL
Practice address
3001 W Dr Martin Luther King Jr Blvd
Tampa, FL 33607-6307
Phone
(813) 870-4000
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS5288 FL Primary

Addresses

Primary practice location

3001 W Dr Martin Luther King Jr Blvd
Tampa, FL 33607-6307

Mailing address

PO Box 10030
Daytona Beach, FL 32120-0030
Phone (386) 274-7800

Other identifiers 3

IdentifierTypeStateIssuer
044826500MedicaidFL
80155OtherFLBLUE CROSS OF FLORIDA
207163OtherFLAMERIGROUP

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 Osteopathy

State licenses

LicenseStateTypeSpecialty
5288FLMDProfessional Counselor
OS5288FLMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baxley Emergency Physicians LLC Emergency Medicine Past Accepting new patients

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": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249257600000",
    "number": "1295777340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10030",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321200030",
            "telephone_number": "386-274-7800",
            "fax_number": "386-274-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 W DR MARTIN LUTHER KING JR BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076307",
            "telephone_number": "813-870-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NILES",
        "first_name": "DAVID",
        "middle_name": "JOHN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2009-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS5288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044826500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF FLORIDA",
            "identifier": "80155",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "207163",
            "state": "FL"
        }
    ],
    "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 Aug 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.