NPIMap

Organization Active NPI

Physicians Professional Alliance, LLC

  • Surgery Physician
  • Brandon, FL
National Provider Identifier
1477179463
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PHYSICIANS PROFESSIONAL ALLIANCE, LLC
Practice address
519 Medical Oaks Ave
Brandon, FL 33511-5961
Phone
(813) 685-7995
Fax
(813) 685-8802
NPI assigned
Jun 25, 2020
Last updated
Jul 6, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNCOAST SURGICAL ASSOCIATES P AAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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

Authorized official

Name
Dr. Gopal S Grandhige, MD
Title
Treasurer
Phone
(813) 684-6006

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU

Addresses

Primary practice location

519 Medical Oaks Ave
Brandon, FL 33511-5961

Mailing address

519 Medical Oaks Ave
Brandon, FL 33511-5961
Phone (813) 685-7995

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210302001204 FL Part B Supplier - Clinic/Group Practice 0547676421 Receives reassigned benefits from 2 practitioners
Practice locations: Brandon, FL

National Provider Directory

National Provider Directory
Part of
Suncoast Surgical Associates PA

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

518 Medical Oaks Ave
Brandon, FL 33511

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1593043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593993600000",
    "number": "1477179463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 MEDICAL OAKS AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115961",
            "telephone_number": "813-685-7995",
            "fax_number": "813-685-8802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 MEDICAL OAKS AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115961",
            "telephone_number": "813-685-7995",
            "fax_number": "813-685-8802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS PROFESSIONAL ALLIANCE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNCOAST SURGICAL ASSOCIATES P A",
        "enumeration_date": "2020-06-25",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A",
        "authorized_official_last_name": "GRANDHIGE",
        "authorized_official_first_name": "GOPAL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "813-684-6006",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; 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.