Active NPI
One Source Medical Group LLC
- Durable Medical Equipment & Medical Supplies
- Tampa, FL
National Provider Identifier
1366653545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 1313496
- Legal business name
- ONE SOURCE MEDICAL GROUP LLC
- Practice address
- 13910 Lynmar Blvd
Tampa, FL 33626 - Phone
- (813) 792-3560
- Fax
- (877) 490-9111
- NPI assigned
- May 27, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Daniel J Robichaud
- Title
- Ceo
- Phone
- (866) 834-7473
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 1313496 | FL | Primary |
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X |
Addresses
Primary practice location
13910 Lynmar Blvd
Tampa, FL 33626
Mailing address
13910 Lynmar Blvd
Tampa, FL 33626-3123
Phone (866) 834-7473
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 032072200 | Medicaid | FL | |
| 5703548 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names 1
- One Source Medical Group LLC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930057944 | FL | DME Supplier - Medical Supply Company | 5597960930 | Practice locations: Tampa, FL |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Durable Medical Equipment & Medical Supplies
- San Antonio, TX
- NPI 1841558160
5597960930
-
- Durable Medical Equipment & Medical Supplies
- Savannah, GA
- NPI 1902369267
5597960930
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| One Souce Medical Group LLC | Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|External Infusion Pumps and/or Supplies|Insulin Infusion Pumps and/or Supplies|Negative Pressure Wound Therapy Pumps/Supplies|Neuromuscular Elect Stimula… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- One Source Medical Group LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- San Antonio, TX
- NPI 1841558160
-
- Durable Medical Equipment & Medical Supplies
- Savannah, GA
- NPI 1902369267
Locations
13910 Lynmar Blvd
Tampa, FL 33626
Phone (813) 792-3560
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180224000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1661299200000",
"number": "1366653545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13910 LYNMAR BLVD",
"city": "TAMPA",
"state": "FL",
"postal_code": "336263123",
"telephone_number": "866-834-7473",
"fax_number": "877-490-9111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13910 LYNMAR BLVD",
"city": "TAMPA",
"state": "FL",
"postal_code": "33626",
"telephone_number": "813-792-3560",
"fax_number": "877-490-9111"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ONE SOURCE MEDICAL GROUP LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-27",
"last_updated": "2022-08-24",
"certification_date": "2022-08-24",
"status": "A",
"authorized_official_last_name": "ROBICHAUD",
"authorized_official_first_name": "DANIEL",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "866-834-7473"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "FL",
"license": "1313496",
"primary": true
},
{
"code": "332BP3500X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "032072200",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
"identifier": "5703548",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "One Source Medical Group LLC",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "One Source Medical Group LLC",
"code": "3",
"type": "Doing Business As"
}
]
}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 24, 2022; 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.