Individual provider Active NPI

Sanil Mathew Skaria, MD

  • Internal Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1770005753
Registry record updated Mar 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME161281 Issued in FL
Practice address
901 22ND Ave S
St Petersburg, FL 33705-2933
Phone
(727) 310-0925
Fax
(727) 498-5470
NPI assigned
Jul 12, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME161281 FL Primary

Addresses

Primary practice location

901 22ND Ave S
St Petersburg, FL 33705-2933

Mailing address

901 22ND Ave S
St Petersburg, FL 33705-2933
Phone (727) 310-0925

Other practice location 1

2800 Main Street
St Vincent Medical Center, Dept of Medicine, Level 3
bridgeport, CT 06606
Phone (475) 988-9147

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
I20230404002712 FL Practitioner - Internal Medicine 4082021803 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lakeview Healthcare System, LLCGroup PAC ID 8921074733, 25 clinicians
Cora Health Services IncGroup PAC ID 1759290992, shared by 21 NPIs, 1,125 clinicians

Practice addresses (Care Compare)

10250 SE 167TH Place Rd
Unit 5
Summerfield, FL 34491-8682
Phone (352) 307-9925

8768 SE 165TH Mulberry LN
The Villages, FL 32162-5861
Phone (352) 329-5237

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeview Healthcare System, LLC CurrentSince Sep 16, 2024 Accepting new patients
Lakeview Healthcare System, LLC Internal Medicine CurrentSince Sep 16, 2024 Accepting new patients

Locations

410 Fern Dr
Leesburg, FL 34748
Phone (352) 218-8200

18550 US Highway 441
Mount Dora, FL 32757
Phone (352) 735-3755

10250 SE 167th Place Rd
Unit 5
Summerfield, FL 34491
Phone (352) 307-9225

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 2

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": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1770005753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 22ND AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337052933",
            "telephone_number": "727-310-0925",
            "fax_number": "727-498-5470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 22ND AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337052933",
            "telephone_number": "727-310-0925",
            "fax_number": "727-498-5470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 Main Street",
            "address_2": "St Vincent Medical Center, Dept of Medicine, Level 3",
            "address_purpose": "LOCATION",
            "city": "bridgeport",
            "state": "CT",
            "postal_code": "06606",
            "country_code": "US",
            "telephone_number": "475-988-9147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKARIA",
        "first_name": "SANIL",
        "middle_name": "MATHEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-12",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME161281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.