Liveactive Multispecialty Physician Group Tampa LLC

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

Legal business name

LIVEACTIVE MULTISPECIALTY PHYSICIAN GROUP TAMPA LLC

Practice address

12440 Cortez Blvd
Brooksville, FL 34613-2628

Phone

(913) 549-3884

NPI assigned

Jan 16, 2024

Organization subpart

No

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

Authorized official

Name

Shane Brethowr

Title

Ceo/Authorized Official

Phone

(913) 549-3884

Specialties & licenses 2

Addresses

Other names 1

• LiveActive Multispecialty Physician Group Tampa Other name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 3

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

• Jose Javier Perez Montalvo, MD

  • Internal Medicine Physician
  • Sarasota, FL
  • NPI 1851721963
  Medicare reassignment NPD
• Monique N Russ, FNP-BC

  • Family Nurse Practitioner
  • Dunedin, FL
  • NPI 1073922076
  Medicare reassignment NPD
• Haseeb Abdul Ahmed, DO

  • Internal Medicine Physician
  • Overland Park, KS
  • NPI 1972701571

  FL, Multi-Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1705363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726272000000",
    "number": "1891556049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1269",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "680051269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12440 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346132628",
            "telephone_number": "913-549-3884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVEACTIVE MULTISPECIALTY PHYSICIAN GROUP TAMPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-16",
        "last_updated": "2024-09-14",
        "certification_date": "2024-09-14",
        "status": "A",
        "authorized_official_last_name": "BRETHOWR",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "CEO/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "913-549-3884"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LiveActive Multispecialty Physician Group Tampa",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Life Imaging Center Inc
• Luke Man Lin, MD
• Lisa Lindauer, MD
• Lisa Allen-Khalil MD PA
• Lisa Gunther Inc
• David W Livesay, PHARMD
• Debra Locicero, MSW
• Shaydon Lillianlynn Loggins
• Anoop Loke
• Jeanette Lollie

• Hospitalist Physician in Brooksville, FL
• Providers in Brooksville, FL by specialty
• Hospitalist Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2024; 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.