Main Street Medical LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

MAIN STREET MEDICAL LLC

Doing business as

Main Street Medical Centers

Practice address

10549 N Florida Ave Ste a
Tampa, FL 33612-6707

Phone

(813) 220-1400

Fax

(813) 440-6484

NPI assigned

Feb 26, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Stephen O Banjoko

Title

Cfo

Phone

(212) 257-0225

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• MAIN STREET MEDICAL CENTERS Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rizwana Hawkeye, DNP

  • Family Nurse Practitioner
  • Tampa, FL
  • NPI 1962971044
  Medicare reassignment Care Compare group NPD
• Oluwakemi Mitchell, DNP, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Land O' Lakes, FL
  • NPI 1861222580

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Chuka Godwin Enebeli, M.D

  • Pain Medicine Physician
  • Orlando, FL
  • NPI 1356705677

  Family Medicine

  Medicare reassignment NPD
• Edmond Njua, MD

  • Internal Medicine Physician
  • Trinity, FL
  • NPI 1700527074
  Medicare reassignment NPD
• Gregory F Saric, M.D., P.C

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1952330771
  Medicare reassignment NPD
• Krystal Taylor

  • Family Nurse Practitioner
  • Tampa, FL
  • NPI 1730678822
  Medicare reassignment NPD
• Maritza Castillo Alfonso

  • Family Nurse Practitioner
  • Brandon, FL
  • NPI 1063285773
  NPD (past)
• Sajedah Taher, DNP

  • Family Nurse Practitioner
  • Pinellas Park, FL
  • NPI 1548819584
  NPD (past)

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

{
    "created_epoch": "1393372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727913600000",
    "number": "1487079505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17175",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336827175",
            "telephone_number": "813-220-1400",
            "fax_number": "813-341-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10549 N FLORIDA AVE STE A",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336126707",
            "telephone_number": "813-220-1400",
            "fax_number": "813-440-6484"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6506 Embassy Blvd",
            "address_purpose": "LOCATION",
            "city": "Port Richey",
            "state": "FL",
            "postal_code": "346684734",
            "country_code": "US",
            "telephone_number": "727-387-8228",
            "fax_number": "727-387-8020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAIN STREET MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-26",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A",
        "authorized_official_last_name": "BANJOKO",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "212-257-0225",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104624600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "LK078",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAIN STREET MEDICAL CENTERS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katrina Maier
• Robin Maier, LCSW
• Rachel Mailliard
• Main Rehab Center LLC
• Main St Medical USA
• Ritika Maini, RBT
• Anna Marie Mainiero
• Manda Emeline Mainville, DO
• Angela M Maio, MD
• Sam Maiocco

• Primary Care Clinic/Center in Tampa, FL
• Providers in Tampa, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.