NPIMap

Organization Active NPI

Informed Medical Decisions, Inc.

Doing business as Informed DNA

  • Genetic Counselor (M.S.)
  • St Petersburg, FL
National Provider Identifier
1568633121
Registry record updated Jan 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Genetic Counselor (M.S.)Taxonomy code 170300000X
Legal business name
INFORMED MEDICAL DECISIONS, INC.
Doing business as
Informed DNA
Practice address
111 2ND Ave NE Ste 700
St Petersburg, FL 33701-3441
Phone
(760) 778-4434
Fax
(800) 930-0961
NPI assigned
Mar 21, 2008
Last updated
Jan 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2022

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

Authorized official

Name
Mr. David Patrick Nixon
Title
Chief Executive Officer
Phone
(760) 778-4434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Genetic Counselor (M.S.)Group: 193400000X SINGLE SPECIALTY GROUP 170300000X Primary

Addresses

Primary practice location

111 2ND Ave NE Ste 700
St Petersburg, FL 33701-3441

Mailing address

PO Box 491
Saint Petersburg, FL 33731-0491
Phone (800) 975-4819

Other names 1

  • Informed DNA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250815001466 FL Part B Supplier - Clinic/Group Practice 2365941598 Receives reassigned benefits from 1 practitioner
Practice locations: St Petersburg, FL

National Provider Directory

National Provider Directory

Locations

111 2nd Ave NE
Ste 700
St Petersburg, FL 33701
Phone (800) 975-4819

1985 Henderson Rd
Columbus, OH 43220
Phone (206) 495-0724

600 Twentyninth Place Ct
Charlottesville, VA 22901

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1206057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1568633121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 491",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337310491",
            "telephone_number": "800-975-4819",
            "fax_number": "800-930-0961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 2ND AVE NE STE 700",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337013441",
            "telephone_number": "760-778-4434",
            "fax_number": "800-930-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFORMED MEDICAL DECISIONS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-21",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "NIXON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "760-778-4434",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "170300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Genetic Counselor, MS",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Informed DNA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Informed DNA",
            "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 Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.