Individual provider Active NPI

Andrew Serge Saint-Vil

  • Occupational Therapy Assistant
  • Tampa, FL
National Provider Identifier
1730710732
Registry record updated Jan 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA16979 Issued in FL
Practice address
4411 N Habana Ave
Tampa, FL 33614-7211
Phone
(813) 872-2771
NPI assigned
Jan 28, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA16979 FL Primary

Addresses

Primary practice location

4411 N Habana Ave
Tampa, FL 33614-7211

Mailing address

1602 Governors Dr Apt 2034
Pensacola, FL 32514-9407
Phone (786) 212-5611

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Dortmund Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OTA16979FLMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1580169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1730710732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 GOVERNORS DR APT 2034",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325149407",
            "telephone_number": "786-212-5611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 N HABANA AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147211",
            "telephone_number": "813-872-2771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAINT-VIL",
        "first_name": "ANDREW",
        "middle_name": "SERGE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-28",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA16979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Dortmund",
            "affiliation": "N",
            "endpointDescription": "NPI",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1602 Governors Dr Apt 2034",
            "city": "Pensacola",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325149407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.