Individual provider Active NPI

Kozhimala Thomas John, MD

  • Internal Medicine Physician
  • Zephyrhills, FL
National Provider Identifier
1891890638
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME23148 Issued in FL
Practice address
6336 Fort King Rd
Zephyrhills, FL 33542
Phone
(727) 322-1054
Fax
(727) 821-7213
NPI assigned
Sep 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X ME23148 FL
Internal Medicine Physician 207R00000X ME23148 FL Primary

Addresses

Primary practice location

6336 Fort King Rd
Zephyrhills, FL 33542

Mailing address

1839 Central Ave
St Petersburg, FL 33713-8900
Phone (727) 322-1054

Other identifiers 2

IdentifierTypeStateIssuer
058391000MedicaidFL
51086OtherBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120124000882 FL Practitioner - Internal MedicinePractitioner - Gastroenterology 5698804466 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME23148FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Health Care of Pinellas LLC Internal Medicine CurrentSince Apr 1, 2021 Accepting new patients
Professional Health Care of Pinellas Inc. CurrentSince Apr 1, 2021 Accepting new patients
Elizabeth a John MD PA Internal Medicine Past Accepting new patients

Locations

1839 Central Ave
St Petersburg, FL 33713
Phone (727) 322-1054

6336 Fort King Rd
Zephyrhills, FL 33542
Phone (813) 640-0060

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIJHAA

Organizations & group practices 3

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1891890638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337138900",
            "telephone_number": "727-322-1054",
            "fax_number": "727-821-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6336 FORT KING RD",
            "city": "ZEPHYRHILLS",
            "state": "FL",
            "postal_code": "33542",
            "telephone_number": "727-322-1054",
            "fax_number": "727-821-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "KOZHIMALA",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME23148",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME23148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058391000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51086",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Zephyrhills, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; 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.