NPIMap

Organization Active NPI

Spine and Orthopaedic Specialists, PLLC

  • Orthopaedic Surgery Physician
  • Odessa, FL
National Provider Identifier
1487743563
Registry record updated Apr 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
ME96330 Issued in FL
Legal business name
SPINE AND ORTHOPAEDIC SPECIALISTS, PLLC
Practice address
2040 Short Ave
Odessa, FL 33556-3427
Phone
(727) 372-9922
Fax
(727) 372-8477
NPI assigned
Oct 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2010

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

Authorized official

Name
Farhan Naveed Siddiqi, MDNPI 1124055306
Title
Partner
Phone
(727) 372-9922

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X ME96330 FL Primary
Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X ME96135 FL
Orthopaedic Surgery of the Spine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207XS0117X ME96135 FL

Addresses

Primary practice location

2040 Short Ave
Odessa, FL 33556-3427

Mailing address

2040 Short Ave
Odessa, FL 33556-3427
Phone (727) 372-9922

Other identifiers 1

IdentifierTypeStateIssuer
ME96330OtherFLPRESIDENT MEDICAL LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070409000055 FL Part B Supplier - Clinic/Group Practice 7416051016 Receives reassigned benefits from 7 practitioners
Practice locations: Odessa, FL

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1104440Spine and Orthopaedic Specialists PLLC2040 Short Ave, Odessa, FL 33556Certificate of waiverSep 2, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272326400000",
    "number": "1487743563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 SHORT AVE",
            "city": "ODESSA",
            "state": "FL",
            "postal_code": "335563427",
            "telephone_number": "727-372-9922",
            "fax_number": "727-372-8477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 SHORT AVE",
            "city": "ODESSA",
            "state": "FL",
            "postal_code": "335563427",
            "telephone_number": "727-372-9922",
            "fax_number": "727-372-8477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE AND ORTHOPAEDIC SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2010-04-27",
        "status": "A",
        "authorized_official_last_name": "SIDDIQI",
        "authorized_official_first_name": "FARHAN",
        "authorized_official_middle_name": "NAVEED",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "727-372-9922",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "FL",
            "license": "ME96330",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "FL",
            "license": "ME96135",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "FL",
            "license": "ME96135",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRESIDENT MEDICAL LICENSE",
            "identifier": "ME96330",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2010; 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.