NPIMap

Organization Active NPI

St Joseph's Diagnostic Center LLC

Doing business as BayCare Outpatient Imaging

  • Diagnostic Radiology Physician
  • Lutz, FL
National Provider Identifier
1780970137
Registry record updated Jan 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ST JOSEPH'S DIAGNOSTIC CENTER LLC
Doing business as
BayCare Outpatient Imaging
Practice address
4091 Van Dyke Rd
Lutz, FL 33558-8007
Phone
(813) 265-6300
NPI assigned
Jun 23, 2011
Last updated
Jan 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2019

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

Authorized official

Name
Tamblyn Cubero
Title
Manager
Phone
(727) 281-9390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

4091 Van Dyke Rd
Lutz, FL 33558-8007

Mailing address

2995 Drew Street
East BLDG 2ND Floor
Clearwater, FL 33759
Phone (727) 281-9390

Other identifiers 1

IdentifierTypeStateIssuer
061048800MedicaidFL

Other names 1

  • BayCare Outpatient Imaging Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040120000332 FL Part B Supplier - Clinic/Group Practice 3779484928 Receives reassigned benefits from 132 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lutz, FL; Riverview, FL; Tampa, FL

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2002152Baycare Outpatient Imaging Van Dyke4091 Van Dyke Rd, Lutz, FL 33558Certificate of waiverJan 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Baycare Outpatient Imaging6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

4091 Van Dyke Rd
Lutz, FL 33558
Phone (813) 265-6300

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547683200000",
    "number": "1780970137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 DREW STREET",
            "address_2": "EAST BLDG 2ND FLOOR",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "33759",
            "telephone_number": "727-281-9390",
            "fax_number": "813-635-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4091 VAN DYKE RD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335588007",
            "telephone_number": "813-265-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH'S DIAGNOSTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-23",
        "last_updated": "2019-01-17",
        "status": "A",
        "authorized_official_last_name": "CUBERO",
        "authorized_official_first_name": "TAMBLYN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "727-281-9390"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "061048800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BayCare Outpatient Imaging",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BayCare Outpatient Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lutz, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.