NPIMap

Organization Active NPI

Dean Medical Inc

  • Family Medicine Physician
  • Lakeland, FL
National Provider Identifier
1619274388
Registry record updated Nov 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS9203 Issued in FL
Legal business name
DEAN MEDICAL INC
Practice address
1500 Lakeland Hills Blvd Ste 4
Lakeland, FL 33805-3257
Phone
(863) 937-7157
Fax
(863) 333-0260
NPI assigned
Feb 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2023

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

Authorized official

Name
Dr. Byron Renard Dean, D.O.NPI 1104851559
Title
Physician
Phone
(863) 937-7157

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X OS9203 FL Primary

Addresses

Primary practice location

1500 Lakeland Hills Blvd Ste 4
Lakeland, FL 33805-3257

Mailing address

3616 Harden Blvd # 311
Lakeland, FL 33803-5938
Phone (863) 937-7157

Other identifiers 1

IdentifierTypeStateIssuer
245345600MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110601000625 FL Part B Supplier - Clinic/Group Practice 7810174711 Receives reassigned benefits from 14 practitioners
Practice locations: Bartow, FL; Lakeland, FL

National Provider Directory

National Provider Directory

Locations

2055 E Georgia St
Bartow, FL 33830
Phone (863) 533-0578

1129 Lakeland Hills Blvd
Lakeland, FL 33805
Phone (863) 594-2433

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1297814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699142400000",
    "number": "1619274388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3616 HARDEN BLVD # 311",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338035938",
            "telephone_number": "863-937-7157",
            "fax_number": "863-333-0260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 LAKELAND HILLS BLVD STE 4",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053257",
            "telephone_number": "863-937-7157",
            "fax_number": "863-333-0260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEAN MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-16",
        "last_updated": "2023-11-05",
        "certification_date": "2023-11-05",
        "status": "A",
        "authorized_official_last_name": "DEAN",
        "authorized_official_first_name": "BYRON",
        "authorized_official_middle_name": "RENARD",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "863-937-7157",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "245345600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2023; 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.