Individual provider Active NPI

Tatiana Stepanova Reynolds, M.D.

  • Family Medicine Physician
  • Brandon, FL
National Provider Identifier
1457309411
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME 93224 Issued in FL
Practice address
119 Oakfield Dr
Brandon, FL 33511-5779
Phone
(407) 788-1906
Fax
(321) 280-2479
NPI assigned
May 4, 2006
Last updated
Sep 24, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME 93224 FL Primary

Addresses

Primary practice location

119 Oakfield Dr
Brandon, FL 33511-5779

Mailing address

PO Box 172181
Tampa, FL 33672-0181
Phone (855) 421-2733

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061101000071 FL Practitioner - Family PracticePractitioner - Emergency Medicine 1951339803 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

119 Oakfield Dr
Brandon, FL 33511-5779
Phone (239) 322-2627

4016 Sun City Ctr Blvd
Sun City Center, FL 33573-5256
Phone (239) 322-2627

6001 Webb Rd
Tampa, FL 33615-3241
Phone (813) 888-7060

701 6TH S St
Saint Petersburg, FL 33701-4891
Phone (239) 322-2627

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 93224FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maxhealth LLC CurrentSince Jun 1, 2013 Accepting new patients
Emcare Physician Providers, Inc. Past Accepting new patients
Fayette Medical Center Past Accepting new patients

Locations

119 Oakfield Dr
Brandon, FL 33511
Phone (813) 571-5150

13681 Doctors Way
Fort Myers, FL 33912
Phone (239) 343-1000

13681 Doctors Way
Rm 18027
Fort Myers, FL 33912
Phone (239) 210-4247

701 6th St S
St Petersburg, FL 33701
Phone (727) 450-1144

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JAICDA

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1457309411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 172181",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336720181",
            "telephone_number": "855-421-2733",
            "fax_number": "760-280-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 OAKFIELD DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115779",
            "telephone_number": "407-788-1906",
            "fax_number": "321-280-2479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "TATIANA",
        "middle_name": "STEPANOVA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME 93224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.