Individual provider Active NPI

Brian Thienemann Macdowell, M.D.

  • Family Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1417911835
Registry record updated Mar 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30836 Issued in NC
Practice address
4724 Dover St NE
Saint Petersburg, FL 33703-2138
Phone
(828) 778-8666
NPI assigned
Apr 13, 2006
Last updated
Mar 25, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 30836 NC Primary
Addiction Medicine (Internal Medicine) Physician 207RA0401X ME130669 FL

Addresses

Primary practice location

4724 Dover St NE
Saint Petersburg, FL 33703-2138

Mailing address

4724 Dover St NE
Saint Petersburg, FL 33703
Phone (828) 778-8666

Other identifiers 4

IdentifierTypeStateIssuer
8953676MedicaidNC
53676OtherNCBCBS
0171620OtherNCUHC
10535300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040414000949 NC Practitioner - Family Practice 9032103635 Practice locations: Asheville, NC
I20190612002495 FL Practitioner - Family Practice 9032103635 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
30836NCMDPharmacist

Networks

  • Optimum HealthCare HMO Network

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774396800000",
    "number": "1417911835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4724 DOVER ST NE",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "33703",
            "telephone_number": "828-778-8666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4724 DOVER ST NE",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337032138",
            "telephone_number": "828-778-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACDOWELL",
        "first_name": "BRIAN",
        "middle_name": "THIENEMANN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "30836",
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "FL",
            "license": "ME130669",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8953676",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "53676",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "0171620",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10535300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.