NPIMap

Organization Active NPI

Diagnostic Clinic Medical Group Inc

  • Family Nurse Practitioner
  • St Petersburg, FL
National Provider Identifier
1356939284
Registry record updated Jan 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
DIAGNOSTIC CLINIC MEDICAL GROUP INC
Practice address
7005 4TH St N
Saint Petersburg, FL 33702-5909
Phone
(727) 501-7300
Fax
(727) 501-7360
NPI assigned
Jan 6, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2021

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

Authorized official

Name
Gina Marie Prebeck
Title
VP of Operations
Phone
(727) 559-9461

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

7005 4TH St N
Saint Petersburg, FL 33702-5909

Mailing address

7005 4TH St N
Saint Petersburg, FL 33702-5909
Phone (727) 501-7300

Other identifiers 1

IdentifierTypeStateIssuer
00036OtherFLFLORIDA BLUE

National Provider Directory

National Provider Directory
Tax ID family
Diagnostic Clinci Med G12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

7005 4th St N
St Petersburg, FL 33702
Phone (727) 501-7300

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1609891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609891200000",
    "number": "1356939284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7005 4TH ST N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337025909",
            "telephone_number": "727-501-7300",
            "fax_number": "727-501-7360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7005 4TH ST N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337025909",
            "telephone_number": "727-501-7300",
            "fax_number": "727-501-7360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC CLINIC MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-06",
        "last_updated": "2021-01-06",
        "certification_date": "2021-01-06",
        "status": "A",
        "authorized_official_last_name": "PREBECK",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "727-559-9461"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "00036",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; 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.