Organization Active NPI

Center for Digestive Diseases PA

  • Gastroenterology Physician
  • St Petersburg, FL
National Provider Identifier
1619900248
Registry record updated Jun 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
ME48637 Issued in FL
Legal business name
CENTER FOR DIGESTIVE DISEASES PA
Practice address
1609 Pasadena Ave S
Ste 3M
St Petersburg, FL 33707-4563
Phone
(727) 384-2016
Fax
(727) 343-3791
NPI assigned
Jul 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2009

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

Authorized official

Name
Ms. Kathy F Jackson
Title
Schedule Coornidator
Phone
(727) 384-2016

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X ME48637 FL Primary

Addresses

Primary practice location

1609 Pasadena Ave S
Ste 3M
St Petersburg, FL 33707-4563

Mailing address

PO Box 20267
Tampa, FL 33622-0267
Phone (727) 823-2188

Other identifiers 3

IdentifierTypeStateIssuer
24038OtherFLBCBS
CL1357OtherFLRAILROAD MEDICARE
373745400MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245283200000",
    "number": "1619900248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20267",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336220267",
            "telephone_number": "727-823-2188",
            "fax_number": "727-828-0723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 PASADENA AVE S",
            "address_2": "STE 3M",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337074563",
            "telephone_number": "727-384-2016",
            "fax_number": "727-343-3791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR DIGESTIVE DISEASES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2009-06-18",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "SCHEDULE COORNIDATOR",
        "authorized_official_telephone_number": "727-384-2016",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME48637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "24038",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CL1357",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373745400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 18, 2009; 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.