Mario E Profet, MD, RDMS, RDCS, RPVI

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ME135981 Issued in FL

Practice address

11017 N Dale Mabry Hwy Ste B
Tampa, FL 33618-3873

Phone

(813) 337-7402

Fax

(813) 461-6462

NPI assigned

Feb 8, 2007

Last updated

Oct 24, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mprofet@dphawcl-fl.direct.office.nextgen.com

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.

• Dr Profet Health & Wellness Center LLC

  • General Practice Physician
  • Tampa, FL
  • NPI 1538711643
  Authorized official Same address or phone
• Aarna Hospitality LLC

  dba Vistara Pharmacy

  • Community/Retail Pharmacy
  • Tampa, FL
  • NPI 1326422189
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571875200000",
    "number": "1487795092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11017 N DALE MABRY HWY STE B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336183873",
            "telephone_number": "133-377-4028",
            "fax_number": "813-461-6462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11017 N DALE MABRY HWY STE B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336183873",
            "telephone_number": "813-337-7402",
            "fax_number": "813-461-6462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROFET",
        "first_name": "MARIO",
        "middle_name": "E",
        "credential": "MD, RDMS, RDCS, RPVI",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2019-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN304",
            "primary": false
        },
        {
            "code": "246XS1301X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist Cardiovascular, Sonography",
            "state": null,
            "license": "76083",
            "primary": false
        },
        {
            "code": "2471S1302X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Sonography",
            "state": null,
            "license": "76083",
            "primary": false
        },
        {
            "code": "2471V0105X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Vascular Sonography",
            "state": null,
            "license": "76083",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME135981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Professional Portable Radiologic Services Inc. (Professional Portable X-ray inc.)
• Professional Portable Radiologic Services Inc. (Dynamic Mobile Imaging)
• Professional Portable Radiologic Services Inc. (Dynamic Mobile Imaging)
• Professional Psychiatric Associates
• Professional Urgent Care Services
• Daniele Profilo, M.S.
• Proformance Sports LLC
• Progress and Change Therapy LLC
• Progressive Family Care LLC
• Progressive Medical Group PA (West Bay Chiropractic)

• General Practice Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.