Individual provider Active NPI

Jacqueline Sherbuk, MD

  • Infectious Disease Physician
  • Tampa, FL
National Provider Identifier
1629480264
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
ME145563 Issued in FL
Practice address
2 Tampa General Cir
Tampa, FL 33606-3571
Phone
(813) 974-2201
NPI assigned
Jun 2, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Infectious Disease Physician 207RI0200X ME145563 FL Primary

Addresses

Primary practice location

2 Tampa General Cir
Tampa, FL 33606-3571

Mailing address

PO Box 917770
Orlando, FL 32891-0001

Other identifiers 2

IdentifierTypeStateIssuer
FMSHGOtherFLBLUE CROSS BLUE SHIELD
107104800MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jsherbuk168981@direct.tgh.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200708001181 FL Practitioner - Infectious Disease 6800116047 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
New York University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Department of HealthGroup PAC ID 3072424282, 126 clinicians
University Medical Service Association IncGroup PAC ID 6800790221, 818 clinicians

Practice addresses (Care Compare)

1105 E Kennedy Blvd
Hillsborough County Health Dep.
Tampa, FL 33602-3511
Phone 81330780156401

12901 Bruce B Downs Blvd
Tampa, FL 33612-4742
Phone (813) 821-8038

4202 E Fowler Ave
Tampa, FL 33620-6750

Hospital & facility affiliations

  • Tampa General Hospital Hospital, Tampa, FL, CCN 100128

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME145563FLMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Department of Health CurrentSince Jan 9, 2024 Accepting new patients
University Medical Service Association Inc CurrentSince Jun 9, 2020 Accepting new patients
Florida Department of Health CurrentSince Jan 9, 2024 Accepting new patients
Tampa General Hospital Current Accepting new patients
University Medical Service Association Inc CurrentSince Jun 9, 2020 Accepting new patients
University Medical Service Association Inc Current Accepting new patients

Locations

12901 Bruce B Downs Blvd
#19
Tampa, FL 33612
Phone (813) 844-4103

12901 Bruce B Downs Blvd
#62
Tampa, FL 33612

4202 E Fowler Ave
Stop SHS100
Tampa, FL 33620
Phone (813) 974-2331

1105 E Kennedy Blvd
Tampa, FL 33602
Phone (813) 307-8015

2 Tampa General Cir
Tampa, FL 33606
Phone (813) 259-8700

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: jsherbuk168981@direct.tgh.org

Organizations & group practices 6

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

Hospital & facility affiliations 1

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": "1401667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1629480264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328910001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 TAMPA GENERAL CIR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336063571",
            "telephone_number": "813-974-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHERBUK",
        "first_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-02",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "FL",
            "license": "ME145563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "FMSHG",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107104800",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsherbuk168981@direct.tgh.org",
            "affiliation": "N",
            "address_1": "2 Tampa General Cir",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336063571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.