NPIMap

Individual provider Active NPI

Jonathan Ross Dattilo, M.D.

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Largo, FL
National Provider Identifier
1790101608
Registry record updated Mar 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
ME144420 Issued in FL
Practice address
12416 66TH St Ste a
Largo, FL 33773-3430
Phone
(727) 547-4700
Fax
(727) 394-8661
NPI assigned
Mar 16, 2014
Last updated
Mar 28, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X ME144420 FL Primary

Addresses

Primary practice location

12416 66TH St Ste a
Largo, FL 33773-3430

Mailing address

12416 66TH St Ste a
Largo, FL 33773-3430
Phone (727) 547-4700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190808000135 DC Practitioner - Orthopedic Surgery 0244501849 Reassigns benefits to 1 organization
I20200709000762 FL Practitioner - Orthopedic Surgery 0244501849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Johns Hopkins University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alexander Medical Group LLCGroup PAC ID 0547299836, 25 clinicians

Practice addresses (Care Compare)

2438 Dr ML King Jr St N
St. Petersburg, FL 33704-2716
Phone (727) 547-4700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement47
Knee replacement42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME144420FLMDAdult Reconstructive Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Clinic LLC Orthopaedic Surgery CurrentSince Jul 29, 2019 Accepting new patients
Alexander Medical Group LLC Orthopaedic Surgery CurrentSince Oct 6, 2022 Accepting new patients
Anderson Clinic LLC Orthopaedic Surgery CurrentSince Jul 29, 2019 Accepting new patients
Coastal Orthopedics & Sports Medicine of Southwest FL, PA Orthopaedic Surgery PastSince Sep 1, 2020 Accepting new patients

Locations

12416 66th St
Ste A
Largo, FL 33773
Phone 7275474700112

1325 Belcher Rd
Ste A
Palm Harbor, FL 34683

5911 N Honore Ave
Ste 120
Sarasota, FL 34243
Phone (941) 355-3223

2438 Dr Ml King Jr St N
St Petersburg, FL 33704
Phone (727) 565-0740

2501 Parkers Ln
Alexandria, VA 22306
Phone (703) 664-7000

2445 Army Navy Dr
Arlington, VA 22206

2800 S Shirlington Rd
Ste 1000
Arlington, VA 22206

Organizations & group practices 4

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1394928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774656000000",
    "number": "1790101608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12416 66TH ST STE A",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337733430",
            "telephone_number": "727-547-4700",
            "fax_number": "727-394-8661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12416 66TH ST STE A",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337733430",
            "telephone_number": "727-547-4700",
            "fax_number": "727-394-8661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATTILO",
        "first_name": "JONATHAN",
        "middle_name": "ROSS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-16",
        "last_updated": "2026-03-28",
        "certification_date": "2026-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "FL",
            "license": "ME144420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

Verify at the official NPI Registry.