Active NPI
Timothy N. Brundage, M.D.
- Internal Medicine Physician
- St Petersburg, FL
National Provider Identifier
1922058775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- ME 88586
- Practice address
- 6500 38TH Ave N
St Petersburg, FL 33710-1629 - Phone
- (727) 344-4795
- Fax
- (727) 344-4712
- NPI assigned
- May 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME 88586 | FL | Primary |
Addresses
Primary practice location
6500 38TH Ave N
St Petersburg, FL 33710-1629
Mailing address
6500 38TH Ave N
St Petersburg, FL 33710-1629
Phone (727) 344-4795
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2704552-00 | Medicaid | FL | |
| 44144 | Other | FL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 88586 | FL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oak Hill Hospitalist, LLC | Internal Medicine | Past | Accepting new patients |
Interoperability endpoints
- timothy.brundage@hca4.eclinicaldirectplus.com
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Brooksville, FL
- NPI 1720152283
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340323200000",
"number": "1922058775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6500 38TH AVE N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337101629",
"telephone_number": "727-344-4795",
"fax_number": "727-344-4712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6500 38TH AVE N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337101629",
"telephone_number": "727-344-4795",
"fax_number": "727-344-4712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNDAGE",
"first_name": "TIMOTHY",
"middle_name": "N.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2012-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME 88586",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2704552-00",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "44144",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.