Dedicated Senior Medical Center St. Petersburg, LLC.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

DEDICATED SENIOR MEDICAL CENTER ST. PETERSBURG, LLC.

Practice address

901 22ND Avenue South
Dedicated Senior Medical Center St. Petersburg, LLC.
St. Petersburg, FL 33705

Phone

(305) 831-4761

NPI assigned

Apr 19, 2017

Organization subpart

No

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

Authorized official

Name

Gladys Fernandez-Cortes

Title

Managing Director

Phone

(305) 498-4034

Specialties & licenses 2

Addresses

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

CLIA laboratory certificates

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1801320528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH STREET",
            "address_2": "CHEN MEDICAL CORPORATE OFFICE",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "33169",
            "telephone_number": "305-831-4761",
            "fax_number": "305-831-4761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 22ND AVENUE SOUTH",
            "address_2": "DEDICATED SENIOR MEDICAL CENTER ST. PETERSBURG, LLC.",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "33705",
            "telephone_number": "305-831-4761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDICATED SENIOR MEDICAL CENTER ST. PETERSBURG, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-19",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ-CORTES",
        "authorized_official_first_name": "GLADYS",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "305-498-4034"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philippe Robert Debroux, OTRL
• Catherine Marie Decker
• Jamie Andrew Decker, MD
• Shelby Decker
• John B Decosmo, DO
• Dedicated Senior Medical Centers of Florida, LLC
• Dedicated Senior Medical Centers of Florida, LLC
• Dedra Hern Crna LLC
• Samantha Dedrick
• Megan Deedrich, FNP-BC

• Specialist in St. Petersburg, FL
• Providers in St. Petersburg, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.