Organization Active NPI

Orthotic & Prosthetic Clinic of Tampa, LLC

  • Durable Medical Equipment & Medical Supplies
  • Palm Harbor, FL
National Provider Identifier
1497530810
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
ORTHOTIC & PROSTHETIC CLINIC OF TAMPA, LLC
Practice address
34760 US Highway 19 N
Palm Harbor, FL 34684-2120
Phone
(813) 466-5006
Fax
(813) 531-8385
NPI assigned
Aug 25, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Authorized official

Name
Mr. Rafael Agustin Diaz Abreu
Title
Owner / Ambr
Phone
(305) 812-5087

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Prosthetic/Orthotic Supplier 335E00000X

Addresses

Primary practice location

34760 US Highway 19 N
Palm Harbor, FL 34684-2120

Mailing address

2754 NW 27TH Ave
Boca Raton, FL 33434-3692
Phone (305) 812-5087

Other names 1

  • ORTHOTIC & PROSTHETIC CLINICS OF AMERICA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240822000177 FL DME Supplier - Medical Supply Company With Orthotic-Prosthetic 1456890466 Practice locations: Palm Harbor, 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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Orthotic & Prosthetic Clinic of Tam34760 US Highway 19 N, Palm Harbor, FL 34684-2120(813) 466-5006 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Aug 29, 2024

National Provider Directory

National Provider Directory

Locations

4809 Memorial Hwy
Ste 101
Tampa, FL 33634

NPI Registry JSON

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

{
    "created_epoch": "1692921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1497530810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2754 NW 27TH AVE",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334343692",
            "telephone_number": "305-812-5087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34760 US HIGHWAY 19 N",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346842120",
            "telephone_number": "813-466-5006",
            "fax_number": "813-531-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOTIC & PROSTHETIC CLINIC OF TAMPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-25",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "DIAZ ABREU",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_middle_name": "AGUSTIN",
        "authorized_official_title_or_position": "OWNER / AMBR",
        "authorized_official_telephone_number": "305-812-5087",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ORTHOTIC & PROSTHETIC CLINICS OF AMERICA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Harbor, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.