NPIMap

Organization Active NPI

Ekg Panel of Blake

  • Cardiovascular Disease Physician
  • Bradenton, FL
National Provider Identifier
1356733695
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
EKG PANEL OF BLAKE
Practice address
2020 59TH St W
Blake Medical Center
Bradenton, FL 34209-4604
Phone
(941) 321-2830
Fax
(504) 588-2165
NPI assigned
Feb 24, 2015
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Ms. Marina Costopoulos
Title
Administrator
Phone
(941) 365-8532

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X FL Primary

Addresses

Primary practice location

2020 59TH St W
Blake Medical Center
Bradenton, FL 34209-4604

Mailing address

PO Box 25548
Ekg Panel of Blake
Sarasota, FL 34277-2548
Phone (941) 321-2830

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150630000109 FL Part B Supplier - Clinic/Group Practice 4880906106 Receives reassigned benefits from 9 practitioners
Practice locations: Bradenton, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1424736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1356733695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25548",
            "address_2": "EKG PANEL OF BLAKE",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342772548",
            "telephone_number": "941-321-2830",
            "fax_number": "504-588-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 59TH ST W",
            "address_2": "BLAKE MEDICAL CENTER",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342094604",
            "telephone_number": "941-321-2830",
            "fax_number": "504-588-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EKG PANEL OF BLAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-24",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "COSTOPOULOS",
        "authorized_official_first_name": "MARINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "941-365-8532",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.