Individual provider Active NPI

Roberto Severino Lluch, MD

  • Psychiatry Physician
  • Tampa, FL
National Provider Identifier
1790879898
Registry record updated Aug 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
ME0059654 Issued in FL
Practice address
5707 N 22ND St
Tampa, FL 33610
Phone
(813) 272-2878
Fax
(813) 272-3766
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X ME0059654 FL Primary

Addresses

Primary practice location

5707 N 22ND St
Tampa, FL 33610

Mailing address

5707 N 22ND St
Tampa, FL 33610
Phone (813) 272-2878

Other identifiers 1

IdentifierTypeStateIssuer
057954800MedicaidFL

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
I20140806001903 FL Practitioner - Psychiatry 9234356726 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ibis Healthcare Inc CurrentSince Jun 5, 2014 Accepting new patients
Ibis Healthcare Inc CurrentSince Jun 5, 2014 Accepting new patients

Locations

5707 N 22nd St
Tampa, FL 33610
Phone (813) 272-2244

2212 E Henry Ave
Tampa, FL 33610
Phone (813) 272-2882

2208 E Henry Ave
Tampa, FL 33610
Phone (813) 239-2882

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1790879898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5707 N 22ND ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33610",
            "telephone_number": "813-272-2878",
            "fax_number": "813-272-3766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5707 N 22ND ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33610",
            "telephone_number": "813-272-2878",
            "fax_number": "813-272-3766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LLUCH",
        "first_name": "ROBERTO",
        "middle_name": "SEVERINO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME0059654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "057954800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.