Individual provider Active NPI

Lawrence Mendiola, D.O.

  • Emergency Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1811258643
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OS13129 Issued in FL
Practice address
500 Dr Martin Luther King St N Ste 303
St Petersburg, FL 33705-1470
Phone
(727) 825-1284
NPI assigned
Jun 7, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS13129 FL Primary

Addresses

Primary practice location

500 Dr Martin Luther King St N Ste 303
St Petersburg, FL 33705-1470

Mailing address

500 Dr Martin Luther King St N Ste 303
St Petersburg, FL 33705-1470
Phone (727) 825-1284

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
I20150731016747 FL Practitioner - Emergency Medicine 0446564652 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of North Texas HSC, College of Osteopathic Med, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bayside Emergency Physicians PAGroup PAC ID 6103988332, 19 clinicians

Practice addresses (Care Compare)

1200 7TH Ave N
St Petersburg, FL 33705-1300
Phone (727) 825-1100

Hospital & facility affiliations

  • St Anthonys Hospital Hospital, Saint Petersburg, FL, CCN 100067

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bayside Emergency Physicians PA Emergency Medicine CurrentSince Jun 1, 2015 Accepting new patients
Observation Medical Group LLC Emergency Medicine CurrentSince Apr 1, 2016 Accepting new patients
Observation Medical Group LLC Emergency Medicine CurrentSince Apr 1, 2016 Accepting new patients
Emergency Medical Associates of Tampa Bay, LLC Emergency Medicine CurrentSince Jul 15, 2015 Accepting new patients

Locations

4211 Van Dyke Rd
Lutz, FL 33558
Phone (813) 265-6300

1200 7th Ave N
St Petersburg, FL 33705
Phone (727) 820-7764

3001 W Mlk Blvd
Tampa, FL 33607
Phone (813) 361-6778

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1339027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521072000000",
    "number": "1811258643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 DR MARTIN LUTHER KING ST N STE 303",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051470",
            "telephone_number": "727-825-1284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 DR MARTIN LUTHER KING ST N STE 303",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051470",
            "telephone_number": "727-825-1284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDIOLA",
        "first_name": "LAWRENCE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-07",
        "last_updated": "2018-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS13129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.