Organization Active NPI

Andrew Rothberg OD PA

  • Optometrist
  • Tampa, FL
National Provider Identifier
1881095545
Registry record updated Jul 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ANDREW ROTHBERG OD PA
Practice address
12950 Race Track Rd
Suite 108
Tampa, FL 33626-1309
Phone
(727) 244-3368
Fax
(832) 934-1166
NPI assigned
Sep 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2020

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

Authorized official

Name
Dr. Andrew Scott Rothberg, ODNPI 1518306943
Title
President
Phone
(813) 854-9000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

12950 Race Track Rd
Suite 108
Tampa, FL 33626-1309

Mailing address

12950 Race Track Rd Ste 111
Tampa, FL 33626-1304
Phone (813) 854-9000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141106001470 FL Part B Supplier - Clinic/Group Practice 1355563362 Receives reassigned benefits from 3 practitioners
Practice locations: Tampa, FL

National Provider Directory

National Provider Directory

Locations

12950 Race Track Rd
Ste 111
Tampa, FL 33626
Phone (813) 854-9000

12950 Race Track Rd
Ste 108
Tampa, FL 33626
Phone (727) 244-3368

Practitioners & affiliated clinicians

Practitioners 3

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": "1410393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594512000000",
    "number": "1881095545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12950 RACE TRACK RD STE 111",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336261304",
            "telephone_number": "813-854-9000",
            "fax_number": "813-579-2063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12950 RACE TRACK RD",
            "address_2": "SUITE 108",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336261309",
            "telephone_number": "727-244-3368",
            "fax_number": "832-934-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREW ROTHBERG OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-11",
        "last_updated": "2020-07-12",
        "certification_date": "2020-07-12",
        "status": "A",
        "authorized_official_last_name": "ROTHBERG",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-854-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 12, 2020; 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.