NPIMap

Individual provider Active NPI

Kaizad P Tamboli, M.D.

  • Internal Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1881753986
Registry record updated Oct 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME91603 Issued in FL
Practice address
2805 54TH Ave N Ste 500
St Petersburg, FL 33714-2414
Phone
(305) 628-6117
Fax
(305) 393-5989
NPI assigned
Dec 6, 2006
Last updated
Oct 29, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 12792 MS
Internal Medicine Physician 207R00000X ME91603 FL Primary

Addresses

Primary practice location

2805 54TH Ave N Ste 500
St Petersburg, FL 33714-2414

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (305) 628-6117

Other practice location 1

4333 15th St
Suite A
Gulfport, MS 39501-2525
Phone (228) 863-4000

Other identifiers 1

IdentifierTypeStateIssuer
00121210MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080311000507 MS Practitioner - Internal Medicine 2062502412 Reassigns benefits to 2 organizations
I20211101003047 FL Practitioner - Internal Medicine 2062502412 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Exceed Physical Therapy, LLCGroup PAC ID 8123378338, 72 clinicians
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

12261 Hwy 49
Gulfport, MS 39503-2976
Phone (228) 265-7185

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2465

3704 Bienville Blvd
Suite B
Ocean Springs, MS 39564-5710
Phone (228) 872-4040

4333 15TH St
Suite a
Gulfport, MS 39501-2525
Phone (228) 863-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME91603FLMDInternal Medicine Physician
12792MSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
Back & Neck Care Center LLC Internal Medicine CurrentSince May 3, 2011 Accepting new patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Nov 1, 2021 Accepting new patients
Dedicated Senior Medical Centers of Florida, LLC CurrentSince Oct 31, 2021 Accepting new patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Nov 1, 2021 Accepting new patients
Img Physicians,LLC Internal Medicine Past Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients
St Tammany Parish Hospital Service District No 1 Internal Medicine Past Accepting new patients
Magnolia Grove Healthcare PastSince Oct 17, 2007 Accepting new patients

Locations

4715 S Florida Ave
Lakeland, FL 33813
Phone (863) 209-7003

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

2805 54th Ave N
Ste 500
St Petersburg, FL 33714
Phone (727) 341-5800

901 22nd Ave S
St Petersburg, FL 33705
Phone (727) 310-0925

1756 Popps Ferry Rd
Ste A
Biloxi, MS 39532
Phone (228) 865-3200

2318 Pass Rd
Ste 7
Biloxi, MS 39531
Phone (228) 385-0088

2699 Pass Rd
Biloxi, MS 39531
Phone (228) 385-0088

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

4500 13th St
#P
Gulfport, MS 39501
Phone (228) 865-3451

Interoperability endpoints

  • Direct secure messaging: ktamboli@direct.mhg.com

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 62

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1881753986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117",
            "fax_number": "305-393-5989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 54TH AVE N STE 500",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337142414",
            "telephone_number": "305-628-6117",
            "fax_number": "305-393-5989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4333 15th St",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Gulfport",
            "state": "MS",
            "postal_code": "395012525",
            "country_code": "US",
            "telephone_number": "228-863-4000",
            "fax_number": "228-863-4003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAMBOLI",
        "first_name": "KAIZAD",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "12792",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME91603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00121210",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.