NPIMap

Organization Active NPI

Observation Medical Group LLC

  • Emergency Medicine Physician
  • Riverview, FL
National Provider Identifier
1467094425
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
OBSERVATION MEDICAL GROUP LLC
Practice address
6901 Simmons Loop
Riverview, FL 33578-9498
Phone
(813) 302-8000
NPI assigned
Oct 11, 2019
Last updated
Oct 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Authorized official

Name
Dion Richard Samerson, MDNPI 1922216027
Title
Authorized Official
Phone
(813) 874-5707

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
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

6901 Simmons Loop
Riverview, FL 33578-9498

Mailing address

PO Box 10855
Daytona Beach, FL 32120-0855
Phone (386) 274-7800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160516001399 FL Part B Supplier - Clinic/Group Practice 3779872627 Receives reassigned benefits from 218 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Riverview, FL; Tampa, FL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 212

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 212

NPI Registry JSON

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1467094425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10855",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321200855",
            "telephone_number": "386-274-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6901 SIMMONS LOOP",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335789498",
            "telephone_number": "813-302-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSERVATION MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "SAMERSON",
        "authorized_official_first_name": "DION",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "813-874-5707",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; 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.