Individual provider Active NPI

Michael Radice, D.C.

  • Chiropractor
  • Lutz, FL
National Provider Identifier
1861527236
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH 8619 Issued in FL
Practice address
18520 N Dale Mabry Hwy
Lutz, FL 33548-7900
Phone
(813) 968-9411
NPI assigned
Feb 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH 8619 FL Primary

Addresses

Primary practice location

18520 N Dale Mabry Hwy
Lutz, FL 33548-7900

Mailing address

18520 N Dale Mabry Hwy
Lutz, FL 33548-7900
Phone (813) 968-9411

Other identifiers 2

IdentifierTypeStateIssuer
381716400MedicaidFL
89228OtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100123000197 FL Practitioner - Chiropractic 5294877619 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

18520 N Dale Mabry Hwy
Lutz, FL 33548-7900
Phone (813) 968-9411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH 8619FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Radice Family Chiropractic, P.a. Chiropractor CurrentSince Jan 23, 2010 Accepting new patients

Locations

18514 N Dale Mabry Hwy
Lutz, FL 33548
Phone (813) 406-4187

18520 N Dale Mabry Hwy
Lutz, FL 33548
Phone (813) 968-9411

Organizations & group practices 1

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": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1861527236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18520 N DALE MABRY HWY",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335487900",
            "telephone_number": "813-968-9411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18520 N DALE MABRY HWY",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335487900",
            "telephone_number": "813-968-9411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADICE",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH 8619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "381716400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "89228",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutz, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.