NPIMap

Organization Active NPI

Diagnostic Clinic Medical Group Inc.

  • Family Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1780080945
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DIAGNOSTIC CLINIC MEDICAL GROUP INC.
Practice address
630 Pasadena Ave S
St Petersburg, FL 33707-2128
Phone
(727) 345-7100
Fax
(727) 345-7102
NPI assigned
Nov 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

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

Authorized official

Name
Gina M Prebeck
Title
VP of Operations
Phone
(727) 581-8767

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

630 Pasadena Ave S
St Petersburg, FL 33707-2128

Mailing address

630 Pasadena Ave S
St Petersburg, FL 33707-2128
Phone (727) 345-7100

National Provider Directory

National Provider Directory
Tax ID family
Diagnostic Clinci Med G12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1415923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1780080945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 PASADENA AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337072128",
            "telephone_number": "727-345-7100",
            "fax_number": "727-345-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 PASADENA AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337072128",
            "telephone_number": "727-345-7100",
            "fax_number": "727-345-7102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC CLINIC MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-14",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A",
        "authorized_official_last_name": "PREBECK",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "727-581-8767"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.