NPIMap

Individual provider Active NPI

Deepak Tikku, M.D.

  • Neurology Physician
  • Debary, FL
National Provider Identifier
1689748345
Registry record updated Apr 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
ME96609 Issued in FL
Practice address
2808 Enterprise Rd
Suite 104
Debary, FL 32713-2753
Phone
(386) 624-6900
Fax
(386) 624-6993
NPI assigned
Nov 17, 2006
Last updated
Apr 8, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME96609 FL
Neurology Physician 2084N0400X ME96609 FL Primary

Addresses

Primary practice location

2808 Enterprise Rd
Suite 104
Debary, FL 32713-2753

Mailing address

2808 Enterprise Rd
Suite 104
Debary, FL 32713-2753
Phone (386) 624-6900

Other identifiers 1

IdentifierTypeStateIssuer
002197200MedicaidFL

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
I20070623000002 FL Practitioner - Neurology 1355440892 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

2808 Enterprise Rd
Suite 104
Debary, FL 32713-2753
Phone (386) 624-6900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME96609FLMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Neurology Center of Florida LLC Specialist CurrentSince Dec 1, 2011 Accepting new patients
Southwest Volusia Healthcare Corporation Past Accepting new patients
Jose J Rosales MD PA Past Accepting new patients

Locations

2808 Enterprise Rd
Ste 104
Debary, FL 32713
Phone (386) 624-6900

301 Skyline Dr
Ste 3
Lady Lake, FL 32159
Phone (352) 209-6211

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 3

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 5

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": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460073600000",
    "number": "1689748345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 ENTERPRISE RD",
            "address_2": "SUITE 104",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "327132753",
            "telephone_number": "386-624-6900",
            "fax_number": "386-624-6993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2808 ENTERPRISE RD",
            "address_2": "SUITE 104",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "327132753",
            "telephone_number": "386-624-6900",
            "fax_number": "386-624-6993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIKKU",
        "first_name": "DEEPAK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2016-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME96609",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME96609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002197200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Debary, FL

Sources for this page

Verify at the official NPI Registry.