Individual provider Active NPI

Dianellys Campos-Jimenez

  • Physician Assistant
  • Tampa, FL
National Provider Identifier
1902621808
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
401 W Kennedy Blvd
Tampa, FL 33606-1450
Phone
(813) 253-3333
NPI assigned
Nov 18, 2024
Last updated
Nov 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

401 W Kennedy Blvd
Tampa, FL 33606-1450

Mailing address

401 W Kennedy Blvd
Tampa, FL 33606-1450
Phone (813) 253-3333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251226000796 FL Practitioner - Physician Assistant 9830685064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Kidney Physicians LLCGroup PAC ID 4385925650, 167 clinicians

Practice addresses (Care Compare)

4710 N Habana Ave
Suite 107
Tampa, FL 33614-7143
Phone (813) 910-8708

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Kidney Physicians , LLC CurrentSince Oct 18, 2025 Accepting new patients
Florida Kidney Physicians, LLC CurrentSince Oct 18, 2025 Accepting new patients

Locations

4710 N Habana Ave
Ste 107
Tampa, FL 33614
Phone (813) 870-3767

12662 Telecom Dr
Temple Terrace, FL 33637
Phone (813) 910-8708

Interoperability endpoints

  • Direct secure messaging: dianellys.campos-jimenez.1@15644.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15644/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1902621808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 W KENNEDY BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336061450",
            "telephone_number": "813-253-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W KENNEDY BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336061450",
            "telephone_number": "813-253-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPOS-JIMENEZ",
        "first_name": "DIANELLYS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.