NPIMap

Organization Active NPI

Wiregrass Direct Primary Care PLLC

  • Family Medicine Physician
  • Wesley Chapel, FL
National Provider Identifier
1649827577
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WIREGRASS DIRECT PRIMARY CARE PLLC
Practice address
2236 Green Hedges Way
Wesley Chapel, FL 33544-8189
Phone
(813) 999-0505
Fax
(813) 701-9450
NPI assigned
Aug 26, 2019
Last updated
Apr 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Authorized official

Name
Dennis Michael Ipock, APRNNPI 1538729710
Title
Manager
Phone
(813) 999-0505

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Primary Care Clinic/Center 261QP2300X
Urgent Care Clinic/Center 261QU0200X
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

2236 Green Hedges Way
Wesley Chapel, FL 33544-8189

Mailing address

2236 Green Hedges Way
Wesley Chapel, FL 33544-8189
Phone (813) 999-0505

Other practice location 1

33853 State Road 54 Ste 102
Zephyrhills, FL 33543-9105
Phone (813) 999-0505

Other identifiers 1

IdentifierTypeStateIssuer
105137300MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191203000766 FL Part B Supplier - Clinic/Group Practice 5890128045 Receives reassigned benefits from 12 practitioners
Practice locations: Wesley Chapel, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2173551Wiregrass Direct Primary Care PLLC2236 Green Hedges Way, Wesley Chapel, FL 33544Certificate of waiverOct 14, 2027

National Provider Directory

National Provider Directory

Locations

2604 Cypress Ridge Blvd
Ste 102I
Wesley Chapel, FL 33544

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23694/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1649827577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2236 GREEN HEDGES WAY",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "335448189",
            "telephone_number": "813-999-0505",
            "fax_number": "813-701-9450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2236 GREEN HEDGES WAY",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "335448189",
            "telephone_number": "813-999-0505",
            "fax_number": "813-701-9450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "33853 State Road 54 Ste 102",
            "address_purpose": "LOCATION",
            "city": "Zephyrhills",
            "state": "FL",
            "postal_code": "335439105",
            "country_code": "US",
            "telephone_number": "813-999-0505",
            "fax_number": "813-701-9450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WIREGRASS DIRECT PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-26",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "IPOCK",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "813-999-0505",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105137300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wesley Chapel, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.