Individual provider Active NPI

Evan B Tepper, MD

  • Pediatrics Physician
  • Bradenton, FL
National Provider Identifier
1699717918
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME60190 Issued in FL
Practice address
206 2ND St E
Bradenton, FL 34208-1042
Phone
(941) 746-5111
NPI assigned
Jun 12, 2006
Last updated
Mar 7, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME60190 FL Primary
General Practice Physician 208D00000X ME60190 FL

Addresses

Primary practice location

206 2ND St E
Bradenton, FL 34208-1042

Mailing address

14050 NW 14TH St
Suite 190
Sunrise, FL 33323-2865
Phone (800) 424-3672

Other identifiers 1

IdentifierTypeStateIssuer
372931101MedicaidFL

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
I20050304000465 FL Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 0648224493 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME60190FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Emergency Physicians Kang and Associates MD LLC Emergency Medicine CurrentSince Jan 15, 2020 Accepting new patients
Susana Lozada-Murray, Psy.D. LLC CurrentSince Dec 25, 2021 Accepting new patients
Inphynet Contracting Services LLC Emergency Medicine Past Accepting new patients
Paragon Contracting Services LLC Emergency Medicine Past Accepting new patients

Locations

400 Celebration Pl
Kissimmee, FL 34747
Phone (407) 303-4000

4728 N Habana Ave
Ste 302
Tampa, FL 33614
Phone (813) 556-2244

1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1699717918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14050 NW 14TH ST",
            "address_2": "SUITE 190",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232865",
            "telephone_number": "800-424-3672",
            "fax_number": "954-377-3042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 2ND ST E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342081042",
            "telephone_number": "941-746-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEPPER",
        "first_name": "EVAN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME60190",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME60190",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372931101",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.