George Sidhom MD PA

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

GEORGE SIDHOM MD PA

Practice address

722 Bowing Oak Dr
Brandon, FL 33511-5974

Phone

(813) 684-7246

Fax

(813) 684-0453

NPI assigned

Sep 26, 2007

Organization subpart

No

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

Authorized official

Name

Jean Sidhom

Title

Billing/Office Manager

Phone

(352) 688-6393

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brandon Pain Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• George Sidhom MD PA

  • Specialist
  • Spring Hill, FL
  • NPI 1255351532

  O20080410000344

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Brandon Pain Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• George Sidhom MD PA

  • Specialist
  • Spring Hill, FL
  • NPI 1255351532
  NPD tax ID

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wessam Gerguis, M.D

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Largo, FL
  • NPI 1548795644
  Medicare reassignment NPD
• George S Sidhom, M.D.

  • Interventional Pain Medicine Physician
  • Spring Hill, FL
  • NPI 1003814435
  Medicare reassignment NPD
• Stephanie Marie Leonard, CRNA

  • Certified Registered Nurse Anesthetist
  • Tampa, FL
  • NPI 1669425948
  NPD (past)
• Marjorie Burry Medina, CRNA

  • Certified Registered Nurse Anesthetist
  • Tampa, FL
  • NPI 1316931322
  NPD (past)
• Gayle Reed, CRNA

  • Certified Registered Nurse Anesthetist
  • Oxford, FL
  • NPI 1841399649
  NPD (past)

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364947200000",
    "number": "1336336130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10478",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346030478",
            "telephone_number": "813-684-7246",
            "fax_number": "813-684-0453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 BOWING OAK DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115974",
            "telephone_number": "813-684-7246",
            "fax_number": "813-684-0453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE SIDHOM MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-26",
        "last_updated": "2013-04-03",
        "status": "A",
        "authorized_official_last_name": "SIDHOM",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "BILLING/OFFICE MANAGER",
        "authorized_official_telephone_number": "352-688-6393"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "97788",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brandon Pain Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Brandon, FL
• Providers in Brandon, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.