NPIMap

Individual provider Active NPI

Reena Jiju Kavilaveettil, MD

  • Neurology Physician
  • Tampa, FL
National Provider Identifier
1629023379
Registry record updated Jun 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
9ME0092765 Issued in FL
Practice address
15267 Amberly Dr
Tampa, FL 33647-2155
Phone
(813) 972-5414
Fax
(813) 972-5413
NPI assigned
May 23, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 9ME0092765 FL Primary

Addresses

Primary practice location

15267 Amberly Dr
Tampa, FL 33647-2155

Mailing address

15267 Amberly Dr
Tampa, FL 33647-2155
Phone (813) 972-5414

Other identifiers 1

IdentifierTypeStateIssuer
272929600MedicaidFL

Other names 1

  • Dr. Reena Jiju Kavilaveettil Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050819000171 FL Practitioner - Neurology 5890725709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians
Sports and Orthopedic Rehabilitation Services IncGroup PAC ID 0840104253, shared by 4 NPIs, 314 clinicians

Practice addresses (Care Compare)

15267 Amberly Dr
Tampa, FL 33647-2155
Phone (813) 972-5414

17470 Brookside Trace CT
Tampa, FL 33647-6201
Phone (813) 443-5042

1940 Tamiami TRL
Suite 104
Port Charlotte, FL 33948-2105
Phone (941) 883-0083

3411 S Dale Mabry Hwy
Suite a Select Physical Therapy
Tampa, FL 33629-8658
Phone (813) 742-9501

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9ME0092765FLMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Neurology Center, Inc. Neurology CurrentSince Aug 15, 2006 Accepting new patients
David W. Malka MD, PA Neurology PastSince Mar 1, 2001 Accepting new patients

Locations

15267 Amberly Dr
Tampa, FL 33647
Phone (813) 972-5414

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EAHABA/Endpoint/EAHABA

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1629023379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15267 AMBERLY DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472155",
            "telephone_number": "813-972-5414",
            "fax_number": "813-972-5413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15267 AMBERLY DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472155",
            "telephone_number": "813-972-5414",
            "fax_number": "813-972-5413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVILAVEETTIL",
        "first_name": "REENA",
        "middle_name": "JIJU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "9ME0092765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272929600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REENA",
            "last_name": "KAVILAVEETTIL",
            "middle_name": "JIJU",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.