Individual provider Active NPI

Jack N. Gay Jr., M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Largo, FL
National Provider Identifier
1720014897
Registry record updated Sep 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
ME58150 Issued in FL
Practice address
1301 2ND Ave SW
Largo, FL 33770-3120
Phone
(727) 935-0500
Fax
(727) 935-0501
NPI assigned
Jun 23, 2006
Last updated
Sep 1, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology Physician 207ND0900X ME58150 FL
Dermatopathology (Pathology) Physician 207ZD0900X ME58150 FL
Anatomic Pathology Physician 207ZP0101X ME58150 FL
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X ME58150 FL Primary
Clinical Pathology Physician 207ZC0006X ME58150 FL

Addresses

Primary practice location

1301 2ND Ave SW
Largo, FL 33770-3120

Mailing address

1301 2ND Ave SW
Largo, FL 33770-3120

Other identifiers 1

IdentifierTypeStateIssuer
261649100MedicaidFL

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
I20060403000150 FL Practitioner - Pathology 0648288605 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Medical College of Georgia School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Academic Alliance in Dermatology IncGroup PAC ID 8729077938, 46 clinicians

Practice addresses (Care Compare)

5210 Webb Rd
Tampa, FL 33615-4518
Phone (813) 882-9986

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME58150FLMDDermatopathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Academic Alliance in Dermatology, PLLC Dermatopathology CurrentSince Apr 1, 2017 Accepting new patients
Ruffolo Hooper & Associates MD PA Dermatopathology CurrentSince Jul 12, 2006 Accepting new patients

Locations

3100 E Fletcher Ave
Tampa, FL 33613
Phone (813) 615-7200

5210 Webb Rd
Tampa, FL 33615
Phone (813) 882-9986

5755 Hoover Blvd
Tampa, FL 33634

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.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1720014897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 2ND AVE SW",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 2ND AVE SW",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703120",
            "telephone_number": "727-935-0500",
            "fax_number": "727-935-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAY",
        "first_name": "JACK",
        "middle_name": "N.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "FL",
            "license": "ME58150",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "FL",
            "license": "ME58150",
            "primary": false
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "FL",
            "license": "ME58150",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME58150",
            "primary": true
        },
        {
            "code": "207ZC0006X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology",
            "state": "FL",
            "license": "ME58150",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261649100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

Verify at the official NPI Registry.