Individual provider Active NPI

Saroja Medidi, M.D.

  • Family Medicine Physician
  • Dover, FL
National Provider Identifier
1346561669
Registry record updated Nov 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME115009 Issued in FL
Practice address
14254 Martin Luther King Blvd
Dover, FL 33527-4414
Phone
(813) 349-7700
Fax
(813) 349-7761
NPI assigned
Jun 21, 2010
Sex
Female
Sole proprietor
Yes

Organizations & group practices 13

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.

View all 13

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suncoast Community Health Centers Inc 30 clinicians

Practice addresses (Care Compare)

14254 Martin Luther King Blvd
Dover, FL 33527-4414
Phone (813) 653-6100

14254 Sr
Suite 574
Dover, FL 33527-4414
Phone (813) 653-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160804000080 IN Practitioner - Family Practice 3779722400 Reassigns benefits to 2 organizations
I20190204002858 FL Practitioner - Family Practice 3779722400 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Suncoast Community Health Centers Inc Single Specialty CurrentSince Dec 17, 2018 Accepting new patients
Sound Physicians of Indiana, LLC Family Medicine CurrentSince Jan 10, 2017 Accepting new patients
Sound Physicians of Indiana, LLC Single Specialty CurrentSince Jan 10, 2017 Accepting new patients
Suncoast Community Health Centers, Inc CurrentSince Dec 17, 2018 Accepting new patients
Hospitalist Medicine Physicians of Indiana, LLC Single Specialty CurrentSince Nov 26, 2017 Accepting new patients
Suncoast Community Health Centers Inc Past Accepting new patients
Suncoast Community Health Centers Inc Family Medicine Past Accepting new patients

Locations

14254 Martin Luther King Blvd
Dover, FL 33527
Phone (813) 349-7700

801 E Baker St
Plant City, FL 33563
Phone (813) 349-7649

13110 Elk Mountain Dr
Riverview, FL 33579
Phone (813) 349-7567

2814 14th Ave SE
Ruskin, FL 33570
Phone (813) 349-7800

601 W 2nd St
Bloomington, IN 47403
Phone (812) 353-5252

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X ME115009 FL Primary

Addresses

NPPES NPI Registry

Primary practice location

14254 Martin Luther King Blvd
Dover, FL 33527-4414

Mailing address

13110 Elk Mountain Dr
Riverview, FL 33579-7182
Phone (813) 349-7568

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
009031800MedicaidFL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 26, 2013.

{
    "created_epoch": "1277078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385424000000",
    "number": "1346561669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13110 ELK MOUNTAIN DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335797182",
            "telephone_number": "813-349-7568",
            "fax_number": "813-349-7561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14254 MARTIN LUTHER KING BLVD",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "335274414",
            "telephone_number": "813-349-7700",
            "fax_number": "813-349-7761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDIDI",
        "first_name": "SAROJA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-21",
        "last_updated": "2013-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME115009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009031800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, FL

Sources for this page

Verify at the official NPI Registry.