Active NPI
Evgeny Idrisov, MD
- Gastroenterology Physician
- Sarasota, FL
National Provider Identifier
1689061830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- PENDING
- Practice address
- 1700 S Tamiami TRL
Sarasota, FL 34239 - Phone
- (941) 917-4896
- Fax
- (941) 917-6884
- NPI assigned
- Apr 24, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME131245 | FL | |
| Gastroenterology Physician | 207RG0100X | ME131245 | FL | |
| Gastroenterology Physician | 207RG0100X | PENDING | OK | Primary |
| Internal Medicine Physician | 207R00000X | TRN21341 | FL |
Addresses
Primary practice location
1700 S Tamiami TRL
Sarasota, FL 34239
Mailing address
PO Box 863407
Orlando, FL 32886-3407
Phone (941) 917-2600
Other practice location 1
800 Stanton L Young Blvd
Oklahoma City, OK 73104-5018
Phone (405) 271-8001 ext. 54287
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Gastroenterology
- Education
- Florida State University College of Medicine, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1900 E Commercial Blvd
201 Holy Cross Medical Group
Ft Lauderdale, FL 33308-3737
Phone (954) 928-1778
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 49 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 112 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME131245 | FL | MD | Internal Medicine Physician |
| PENDING | OK | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holy Cross Hospital, Inc | Current | Accepting new patients | |
| Holy Cross Hospital Inc | Single Specialty | Current | Accepting new patients |
Locations
4701 N Federal Hwy
Ste B
Ft Lauderdale, FL 33308
Phone (954) 229-6000
1309 S Federal Hwy
#G
Ft Lauderdale, FL 33316
Phone (954) 463-4383
1900 E Commercial Blvd
Ste 201
Ft Lauderdale, FL 33308
Phone (954) 351-5857
Interoperability endpoints
- eidrisov2068284@direct.trinity-health.org
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 and National Provider Directory roles.
-
- Internal Medicine Physician
- Ft. Lauderdale, FL
- NPI 1467401877
Single Specialty
-
- Health & Wellness Coach
- Oakland Park, FL
- NPI 1063207595
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Ft Lauderdale, FL
- NPI 1639197395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656979200000",
"number": "1689061830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 863407",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328863407",
"telephone_number": "941-917-2600",
"fax_number": "941-917-7884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 S TAMIAMI TRL",
"city": "SARASOTA",
"state": "FL",
"postal_code": "34239",
"telephone_number": "941-917-4896",
"fax_number": "941-917-6884"
}
],
"practiceLocations": [
{
"address_1": "800 Stanton L Young Blvd",
"address_purpose": "LOCATION",
"city": "Oklahoma City",
"state": "OK",
"postal_code": "731045018",
"country_code": "US",
"telephone_number": "405-271-8001 x54287",
"fax_number": "405-271-5803",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "IDRISOV",
"first_name": "EVGENY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-24",
"last_updated": "2022-07-05",
"certification_date": "2022-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME131245",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Gastroenterology",
"state": "FL",
"license": "ME131245",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "OK",
"license": "PENDING",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "TRN21341",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sarasota, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.