Mountcastle Vein Center of St Petersburg

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ME36289 Issued in FL

Legal business name

MOUNTCASTLE VEIN CENTER OF ST PETERSBURG

Practice address

5901 Sun Blvd
Suite 113a
St Petersburg, FL 33715-1166

Phone

(727) 865-6941

Fax

(727) 864-0929

NPI assigned

Jan 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Daniel J Mountcastle, M.D.

Title

President

Phone

(727) 865-6941

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph James Fastaia, M.D.

  • Internal Medicine Physician
  • Miami Beach, FL
  • NPI 1508937103
  NPD (past)
• Naushin Khan Jobe, MD

  • Pediatrics Physician
  • St Petersburg, FL
  • NPI 1861492043
  NPD (past)
• Jack Morgan Lipps, MD

  • Obstetrics & Gynecology Physician
  • St Petersburg, FL
  • NPI 1487621132

  General Practice

  NPD (past)
• Brian Leo Taylor, MD

  • Family Medicine Physician
  • Bay Pines, FL
  • NPI 1447202973
  NPD (past)
• Todd Lee Gracen, M.D.

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1639397904
  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416441600000",
    "number": "1619022951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 SUN BLVD",
            "address_2": "SUITE 201",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337151166",
            "telephone_number": "727-865-6941",
            "fax_number": "727-864-0929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 SUN BLVD",
            "address_2": "SUITE 113A",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337151166",
            "telephone_number": "727-865-6941",
            "fax_number": "727-864-0929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTCASTLE VEIN CENTER OF ST PETERSBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2014-11-20",
        "status": "A",
        "authorized_official_last_name": "MOUNTCASTLE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-865-6941",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME36289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "3027OT",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "039342800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "ME36289",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Motive Physical Therapy & Performance
• Carl Tywan Moton, RMHCI
• Michelle R Mottern, APRN
• Nasser A Moukaddem, MD
• Caitlin Moulton
• Daniel J Mountcastle, M.D.
• Gayle Maude Mousseau, RD,LD
• Britten Moyers, M.S.
• MRI Associates of St Pete Inc
• Jana Mrkaja

• General Practice Physician in St Petersburg, FL
• Providers in St Petersburg, 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 Nov 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.