Diana Revenco, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

ME146373 Issued in FL

Practice address

6919 N Dale Mabry Hwy Ste 125
Tampa, FL 33614-3972

Phone

(813) 497-9661

Fax

(813) 615-8468

NPI assigned

May 2, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Interventional Cardiology

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Group practices

Florida Hospital Physician Group IncGroup PAC ID 2365679057, 953 clinicians

West Florida Cardiovascular Co-Management Associates, LLCGroup PAC ID 0547538316, 36 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Tampa Hospital, Tampa, FL, CCN 100173
• AdventHealth Carrollwood Hospital, Tampa, FL, CCN 100069
• Adventhealth North Pinellas Hospital, Tarpon Springs, FL, CCN 100055
• Adventhealth Wesley Chapel Hospital, Wesley Chapel, FL, CCN 100319

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: drevenco1543552@adventhealth.direct-ci.com

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.

• Florida Hospital Physician Group Inc

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1174955256
  Medicare reassignment Care Compare group NPD
• West Florida Cardiovascular Co-Management Associates, LLC

  • Cardiovascular Disease Physician
  • Tampa, FL
  • NPI 1245776004
  Medicare reassignment Care Compare group NPD
• Wentworth Douglass Physician Corporation

  • Diagnostic Radiology Physician
  • Somersworth, NH
  • NPI 1295326494
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pasco-Pinellas Hillsborough Community Health System Inc

  • General Acute Care Hospital
  • Wesley Chapel, FL
  • NPI 1073893020
  Care Compare affiliation
• Tarpon Springs Hospital Foundation Inc

  • General Acute Care Hospital
  • Tarpon Springs, FL
  • NPI 1568473015
  Care Compare affiliation
• University Community Hospital, Inc

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1053321919
  Care Compare affiliation
• University Community Hospital, Inc

  • Clinical Medical Laboratory
  • Tampa, FL
  • NPI 1134766694

  Hospital

  Care Compare affiliation
• University Community Hospital, Inc

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1427068345
  Care Compare affiliation

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

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1386810091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 9TH AVE",
            "address_2": "MS:M4-PFS",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012756",
            "telephone_number": "206-515-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6919 N DALE MABRY HWY STE 125",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336143972",
            "telephone_number": "813-497-9661",
            "fax_number": "813-615-8468"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 9th Ave",
            "address_2": "MS:X3-CAR",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981012756",
            "country_code": "US",
            "telephone_number": "206-341-1111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REVENCO",
        "first_name": "DIANA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-02",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "NH",
            "license": "15634",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WA",
            "license": "MD60668587",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME146373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01138997",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3075998",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386810091",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Cardiovascular Disease Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Cardiovascular Disease Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.

Verify at the official NPI Registry.