NPIMap

Organization Active NPI

Baycare Outpatient Imaging LLC

  • Diagnostic Radiology Physician
  • Valrico, FL
National Provider Identifier
1417423377
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
BAYCARE OUTPATIENT IMAGING LLC
Practice address
2470 Bloomingdale Ave Ste 115
Valrico, FL 33596-6403
Phone
(727) 281-9479
Fax
(813) 586-8516
NPI assigned
Oct 18, 2018
Last updated
Jul 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Lynda A Gorken
Title
VP, PFS
Phone
(727) 281-9065

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

2470 Bloomingdale Ave Ste 115
Valrico, FL 33596-6403

Mailing address

2995 Drew Street
East BLDG 2ND Floor
Clearwater, FL 33759
Phone (727) 281-9390

Other identifiers 1

IdentifierTypeStateIssuer
101818500MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190410002311 FL Part B Supplier - Clinic/Group Practice 3577804087 Receives reassigned benefits from 177 practitioners
6 other NPIs on this enrollment
Practice locations: Wesley Chapel, FL; Winter Haven, FL; Valrico, FL; Tampa, FL; Plant City, FL; Land O Lakes, FL

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Baycare Outpatient Imaging LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

3198 N Park Rd
Ste 102
Plant City, FL 33563
Phone (813) 757-1204

11802 N Dale Mabry Hwy
Ste 102
Tampa, FL 33618

4503 Bruce B Downs Blvd
#104
Wesley Chapel, FL 33544

Practitioners & affiliated clinicians

Practitioners 180

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.

View all 180

NPI Registry JSON

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

{
    "created_epoch": "1539820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1417423377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 DREW STREET",
            "address_2": "EAST BLDG 2ND FLOOR",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "33759",
            "telephone_number": "727-281-9390",
            "fax_number": "813-635-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2470 BLOOMINGDALE AVE STE 115",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335966403",
            "telephone_number": "727-281-9479",
            "fax_number": "813-586-8516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYCARE OUTPATIENT IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-18",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "GORKEN",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP, PFS",
        "authorized_official_telephone_number": "727-281-9065"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101818500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valrico, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.