Subhakararao Medidi, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME48578 Issued in FL

Practice address

14254 State Road 574
Tom Lee Community Health Center
Dover, FL 33527-4312

Phone

(813) 349-7700

Fax

(813) 349-7761

NPI assigned

Aug 23, 2006

Last updated

Nov 23, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Suncoast Community Health Centers IncGroup PAC ID 3870402548, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: subhakararao.medidi@suncoastchc.eclinicaldirectplus.com

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.

• Suncoast Community Health Centers Inc

  dba Ruskin Health Center

  • Federally Qualified Health Center (FQHC)
  • Ruskin, FL
  • NPI 1285644799
  Medicare reassignment Care Compare group NPD
• Suncoast Community Health Centers Inc

  dba Tom Lee Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Dover, FL
  • NPI 1144230640
  NPD
• Suncoast Community Health Centers, Inc

  dba Wimauma Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Wimauma, FL
  • NPI 1518388354
  NPD
• Suncoast Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Ruskin, FL
  • NPI 1104836600

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322006400000",
    "number": "1942317516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13110 ELK MOUNTAIN DR",
            "address_2": "SUNCOAST COMMUNITY HEALTH CENTERS INC",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335797182",
            "telephone_number": "813-349-7562",
            "fax_number": "813-349-7561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14254 STATE ROAD 574",
            "address_2": "TOM LEE COMMUNITY HEALTH CENTER",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "335274312",
            "telephone_number": "813-349-7700",
            "fax_number": "813-349-7761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDIDI",
        "first_name": "SUBHAKARARAO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2011-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME48578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373811600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erixis Lopez, PA
• Mirta Lugo, APRN
• Jacob Lynch, FNP-BC
• Christopher Mathew, OTD, OTR/L
• Saroja Medidi, M.D.
• Jacquelyn Mentor, ED.D
• Carlita Dionne Miller
• Jennifer Lyn Miller, RPH
• Christina Trang Nguyen, PHARMD
• Nurture and Bloom Postpartum Care, LLC

• Family Medicine Physician in Dover, FL
• Providers in Dover, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.