NPIMap

Organization Active NPI

West Florida Trauma Network, LLC

  • Trauma Surgery Physician
  • Bradenton, FL
National Provider Identifier
1902198948
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
Legal business name
WEST FLORIDA TRAUMA NETWORK, LLC
Practice address
2010 59TH St W
Suite 2200
Bradenton, FL 34209-4616
Phone
(813) 453-0590
NPI assigned
May 10, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Authorized official

Name
William Tedrick Johnson
Title
Group Vice President/Ao
Phone
(615) 372-3375

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193200000X MULTI-SPECIALTY GROUP 204E00000X
Trauma Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0127X Primary

Addresses

Primary practice location

2010 59TH St W
Suite 2200
Bradenton, FL 34209-4616

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4525
Phone (615) 373-7600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110722000524 FL Part B Supplier - Clinic/Group Practice 7911175658 Receives reassigned benefits from 24 practitioners
Practice locations: Trinity, FL; Tampa, FL; St Petersburg, FL; South Pasadena, FL; New Port Richey, FL; Largo, FL; Lakewood Ranch, FL; Kissimmee, FL…

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2010 59th St W
Ste 1700
Bradenton, FL 34209
Phone (941) 752-2789

7529 Medical Dr
Hudson, FL 34667
Phone (727) 862-6524

14100 Fivay Rd
Ste 280
Hudson, FL 34667
Phone (727) 862-6524

720 W Oak St
Ste 312
Kissimmee, FL 34741
Phone (407) 846-3166

Practitioners & affiliated clinicians

Practitioners 120

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

View all 120

NPI Registry JSON

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

{
    "created_epoch": "1304985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1902198948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274525",
            "telephone_number": "615-373-7600",
            "fax_number": "866-346-1426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 59TH ST W",
            "address_2": "SUITE 2200",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342094616",
            "telephone_number": "813-453-0590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FLORIDA TRAUMA NETWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-10",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "TEDRICK",
        "authorized_official_title_or_position": "GROUP VICE PRESIDENT/AO",
        "authorized_official_telephone_number": "615-372-3375"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.