Organization Active NPI

Berland Medical Group LLC

  • Family Medicine Physician
  • Tampa, FL
National Provider Identifier
1376052019
Registry record updated Sep 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME83967 Issued in FL
Legal business name
BERLAND MEDICAL GROUP LLC
Practice address
11792 Lake Aston CT Ste a
Tampa, FL 33626-3135
Phone
(813) 690-0225
Fax
(877) 992-6777
NPI assigned
Sep 26, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2017

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

Authorized official

Name
Gregory A Berland, MDNPI 1265427405
Title
Owner
Phone
(813) 690-0225

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X ME83967 FL Primary

Addresses

Primary practice location

11792 Lake Aston CT Ste a
Tampa, FL 33626-3135

Mailing address

2410 Northside Dr
Clearwater, FL 33761-2236
Phone (727) 499-0356

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171220000570 FL Part B Supplier - Clinic/Group Practice 4789942723 Receives reassigned benefits from 2 practitioners
Practice locations: Tampa, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1506384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506384000000",
    "number": "1376052019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 NORTHSIDE DR",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337612236",
            "telephone_number": "727-499-0356",
            "fax_number": "727-781-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11792 LAKE ASTON CT STE A",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336263135",
            "telephone_number": "813-690-0225",
            "fax_number": "877-992-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERLAND MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-26",
        "last_updated": "2017-09-26",
        "status": "A",
        "authorized_official_last_name": "BERLAND",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-690-0225",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME83967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Sep 26, 2017; 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.