St. Anthony'S Professional Buildings & Services, Inc
Organization Active NPI Diagnostic Radiology Physician · St Petersburg, FL
NPI 1487908323 · NPPES record last updated Aug 21, 2023
Key facts
- NPI
- 1487908323
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- ST. ANTHONY'S PROFESSIONAL BUILDINGS & SERVICES, INC
- Practice address
- 620 10TH St N Ste 100
St Petersburg, FL 33705-1407 - Phone
- (727) 825-1045
- NPI assigned
- Oct 30, 2012
- Organization subpart
- No
Authorized official
- Name
- Tamblyn Cubero
- Title
- Cfo
- Phone
- (727) 315-6974
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 5
Practitioners 39
-
Grant Xavier Abadal, M.D.
-
John Bertozzi, M.D.
-
Thomas J Egan, MD
-
Paul Joseph Farnsworth, D.O.
-
Kevin F Garner, MD
-
Benjamin Garrott, M.D.
-
Alexander Rd Johnson, M.D.
-
Stephen Joseph Kennedy, M.D.
-
Nicholas Francis Lambert, D.O.
-
Kyle G Luecke, M.D.
-
Kevin W Marcum, M.D.
-
Brian Neal Moss, D.O.
-
Matthew J Rahaim, MD
-
Geraldo A Ramos, MD
-
Jeffrey Wayne Rasband, D.O.
-
Patrick Hoi Ginn Redmond, M.D.
-
Vincent B Rowley, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2050301 | Baycare Outpatient Imaging at St Anthonys | Certificate of waiver | Nov 25, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040611001120 | FL | Part B Supplier - Clinic/Group Practice | 6507849239 |
Receives reassigned benefits from 43 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Saint Petersburg, FL; St. Petersburg, FL |
National Provider Directory
- Tax ID family
- St Anthony'S Professional Buildings and Services Inc
Locations
100 Highland Ave N
Largo, FL 33770
Phone (727) 683-2900
1201 5th Ave N
Ste 100
St Petersburg, FL 33705
Phone (727) 820-7000
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
620 10TH St N Ste 100
St Petersburg, FL 33705-1407
Mailing address
2995 Drew Street
East BLDG 2ND Floor
Clearwater, FL 33759
Phone (727) 281-9390
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019364701 | Medicaid | FL |
Other names
- BayCare Outpatient Imaging
Other providers in St Petersburg, FL
- St Petersburg SNF Operations LLC
- St Petersburg Surgery Center LTD
- St Petersburg Uscg Phcy
- St. Anthony'S Professional Buildings & Services, Inc
- St. Anthony'S Professional Buildings & Services, Inc
- St. Anthony'S Professional Buildings & Services, Inc
- St. Anthony'S Professional Buildings & Services, Inc
- St. Anthonys Hospital, Inc.
- St. Anthonys Hospital, Inc.
- St. Anthonys Hospital, Inc.
All providers in St Petersburg, FL · Diagnostic Radiology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.