NPIMap

Organization Active NPI

Diagnostic Clinic Medical Group, Inc.

  • Family Medicine Physician
  • South Pasadena, FL
National Provider Identifier
1851997985
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.
Practice address
1615 Pasadena Ave S Ste 220
South Pasadena, FL 33707-4517
Phone
(727) 345-7100
Fax
(727) 345-7102
NPI assigned
Dec 4, 2020
Organization subpart
Yes
Parent organization
DIAGNOSTIC CLINIC MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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

Authorized official

Name
Gina Marie Prebeck
Title
VP of Operations
Phone
(727) 559-9461

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1615 Pasadena Ave S Ste 220
South Pasadena, FL 33707-4517

Mailing address

1615 Pasadena Ave S Ste 220
South Pasadena, FL 33707-4517
Phone (727) 345-7100

Other identifiers 1

IdentifierTypeStateIssuer
00036OtherFLFLORIDA BLUE

National Provider Directory

National Provider Directory
Tax ID family
Diagnostic Clinci Med G12 organizations share this tax ID, including this one
Part of
Diagnostic Clinci Med G

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1615 Pasadena Ave S
Ste 220
South Pasadena, FL 33707
Phone (727) 341-0551

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1851997985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 PASADENA AVE S STE 220",
            "city": "SOUTH PASADENA",
            "state": "FL",
            "postal_code": "337074517",
            "telephone_number": "727-345-7100",
            "fax_number": "727-345-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 PASADENA AVE S STE 220",
            "city": "SOUTH PASADENA",
            "state": "FL",
            "postal_code": "337074517",
            "telephone_number": "727-345-7100",
            "fax_number": "727-345-7102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC CLINIC MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIAGNOSTIC CLINIC MEDICAL GROUP, INC.",
        "enumeration_date": "2020-12-04",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "PREBECK",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "727-559-9461"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "00036",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Pasadena, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.