Individual provider Active NPI

Roxanne Sasha Gaye Samuels Lockett, M.D.

  • Hospitalist Physician
  • Tampa, FL
National Provider Identifier
1700220571
Registry record updated Jan 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
ME128001 Issued in FL
Practice address
3001 W Dr Martin Luther King Jr Blvd
Tampa, FL 33607-6307
Phone
(813) 554-8093
NPI assigned
Apr 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME128001 FL
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X ME128001 FL Primary

Addresses

Primary practice location

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

Mailing address

PO Box 917770
Orlando, FL 32891-7770
Phone (813) 974-2201

Other identifiers 1

IdentifierTypeStateIssuer
018193200MedicaidFL

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
I20160920001368 FL Practitioner - HospitalistPractitioner - Pediatric Medicine 5092017202 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Service Association Inc CurrentSince Sep 4, 2016 Accepting new patients
University Medical Service Association Inc Current Accepting new patients
University Medical Service Association Inc CurrentSince Sep 4, 2016 Accepting new patients

Locations

12901 Bruce B Downs Blvd
#62
Tampa, FL 33612

4202 E Fowler Ave
Stop SHS100
Tampa, FL 33620
Phone (813) 974-2331

3500 E Fletcher Ave
Ste 100
Tampa, FL 33613
Phone (813) 282-8520

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1366761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515974400000",
    "number": "1700220571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328917770",
            "telephone_number": "813-974-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 W DR MARTIN LUTHER KING JR BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076307",
            "telephone_number": "813-554-8093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELS LOCKETT",
        "first_name": "ROXANNE",
        "middle_name": "SASHA GAYE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-24",
        "last_updated": "2018-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME128001",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "FL",
            "license": "ME128001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018193200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.