Individual provider Active NPI

Juan C Abanses, MD

  • Pediatric Emergency Medicine (Emergency Medicine) Physician
  • Tampa, FL
National Provider Identifier
1699760678
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Emergency Medicine) PhysicianTaxonomy code 207PP0204X
License
ME114914 Issued in FL
Practice address
3001 W Dr Martin Luther King Jr Blvd
Em Dept
Tampa, FL 33607-6307
Phone
(813) 870-4000
Fax
(386) 274-7801
NPI assigned
Sep 15, 2005
Last updated
Jul 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X ME114914 FL Primary

Addresses

Primary practice location

3001 W Dr Martin Luther King Jr Blvd
Em Dept
Tampa, FL 33607-6307

Mailing address

PO Box 9790
Daytona Beach, FL 32120-9790
Phone (386) 274-7800

Other identifiers 3

IdentifierTypeStateIssuer
117409500MedicaidFL
14P1ROtherFLBCBS
GX151ZOtherFLMEDICARE PTAN

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
I20130201000163 FL Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 1658356266 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME114914FLMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medical Associates of Tampa Bay, LLC Emergency Medicine CurrentSince Jan 15, 2013 Accepting new patients
Observation Medical Group LLC Emergency Medicine CurrentSince Sep 23, 2024 Accepting new patients
Observation Medical Group LLC Emergency Medicine CurrentSince Sep 23, 2024 Accepting new patients
Tennessee Valley Pediatric Sedation Services Past Accepting new patients

Locations

4211 Van Dyke Rd
Lutz, FL 33558
Phone (813) 443-2010

6901 Simmons Loop
Riverview, FL 33578
Phone (813) 302-8000

3001 W Mlk Blvd
Tampa, FL 33607
Phone (813) 361-6778

4501 Bruce B Downs Blvd
Zephyrhills, FL 33544
Phone (813) 870-4000

Organizations & group practices 4

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": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1699760678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9790",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321209790",
            "telephone_number": "386-274-7800",
            "fax_number": "386-274-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 W DR MARTIN LUTHER KING JR BLVD",
            "address_2": "EM DEPT",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076307",
            "telephone_number": "813-870-4000",
            "fax_number": "386-274-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABANSES",
        "first_name": "JUAN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "FL",
            "license": "ME114914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117409500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "14P1R",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "GX151Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.