NPIMap

Organization Active NPI

St Joseph's Diagnostic Center LLC

Doing business as BayCare Outpatient Imaging

  • Diagnostic Radiology Physician
  • Tampa, FL
National Provider Identifier
1821527474
Registry record updated Jan 18, 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
17512 Dona Michelle Dr Ste 5
Tampa, FL 33647-3265
Phone
(813) 586-7650
NPI assigned
Jun 7, 2017
Last updated
Jan 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2019

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

Authorized official

Name
Tamblyn Cubero
Title
VP
Phone
(727) 281-9093

Specialties & licenses 1

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

Addresses

Primary practice location

17512 Dona Michelle Dr Ste 5
Tampa, FL 33647-3265

Mailing address

2995 Drew St FL 2
Clearwater, FL 33759-3012
Phone (727) 281-9065

Other identifiers 1

IdentifierTypeStateIssuer
061048806MedicaidFL

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.

National Provider Directory

National Provider Directory

Locations

10141 Big Bend Rd
Riverview, FL 33578
Phone (813) 302-8925

12780 Race Track Rd
Tampa, FL 33626
Phone (813) 635-2110

14310 N Dale Mabry Hwy
Ste 100
Tampa, FL 33618
Phone (813) 960-2808

Practitioners & affiliated clinicians

Practitioners 105

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 105

NPI Registry JSON

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547769600000",
    "number": "1821527474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 DREW ST FL 2",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337593012",
            "telephone_number": "727-281-9065",
            "fax_number": "813-635-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17512 DONA MICHELLE DR STE 5",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336473265",
            "telephone_number": "813-586-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH'S DIAGNOSTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-07",
        "last_updated": "2019-01-18",
        "status": "A",
        "authorized_official_last_name": "CUBERO",
        "authorized_official_first_name": "TAMBLYN",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "727-281-9093"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "061048806",
            "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 Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.