NPIMap

Organization Active NPI

St. Anthony's Professional Buildings & Services, Inc

Doing business as BayCare Outpatient Imaging

  • Diagnostic Radiology Physician
  • St Petersburg, FL
National Provider Identifier
1487908323
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ST. ANTHONY'S PROFESSIONAL BUILDINGS & SERVICES, INC
Doing business as
BayCare Outpatient Imaging
Practice address
620 10TH St N Ste 100
St Petersburg, FL 33705-1407
Phone
(727) 825-1045
NPI assigned
Oct 30, 2012
Last updated
Aug 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Tamblyn Cubero
Title
Cfo
Phone
(727) 315-6974

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

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 names 1

  • BayCare Outpatient Imaging Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
10D2050301Baycare Outpatient Imaging at St Anthonys620 10TH St N Ste 100, Saint Petersburg, FL 33705Certificate of waiverNov 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
St Anthony's Professional Buildings and Services Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1201 5th Ave N
St Petersburg, FL 33705
Phone (727) 820-7000

1201 5th Ave N
Ste 100
St Petersburg, FL 33705
Phone (727) 820-7000

620 10th St N
Ste 100
St Petersburg, FL 33705
Phone (727) 502-4200

900 Carillon Pkwy
St Petersburg, FL 33716
Phone (727) 556-2662

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Practitioners & affiliated clinicians

Practitioners 39

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.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1487908323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 DREW STREET",
            "address_2": "EAST BLDG 2ND FLOOR",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "33759",
            "telephone_number": "727-281-9390",
            "fax_number": "813-635-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 10TH ST N STE 100",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051407",
            "telephone_number": "727-825-1045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ANTHONY'S PROFESSIONAL BUILDINGS & SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "CUBERO",
        "authorized_official_first_name": "TAMBLYN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "727-315-6974"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BayCare Outpatient Imaging",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BayCare Outpatient Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.