Organization Active NPI

Gerardo P. Sison, Jr., M.D., P.a.

  • Psychiatry Physician
  • Palm Harbor, FL
National Provider Identifier
1962678110
Registry record updated Mar 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
ME53725 Issued in FL
Legal business name
GERARDO P. SISON, JR., M.D., P.A.
Practice address
34650 US Highway 19 N
Suite 107
Palm Harbor, FL 34684-2155
Phone
(727) 787-3422
Fax
(727) 787-5624
NPI assigned
May 7, 2008
Organization subpart
Yes
Parent organization
GERARDO P. SISON, JR., M.D.. P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2012

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

Authorized official

Name
Mrs. Virginia Dee Sison
Title
Office Manager
Phone
(727) 787-3422

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X ME53725 FL Primary

Addresses

Primary practice location

34650 US Highway 19 N
Suite 107
Palm Harbor, FL 34684-2155

Mailing address

34650 US Highway 19 N
Suite 107
Palm Harbor, FL 34684-2155
Phone (727) 787-3422

Other identifiers 1

IdentifierTypeStateIssuer
064334300MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120214000711 FL Part B Supplier - Clinic/Group Practice 8820265739 Receives reassigned benefits from 1 practitioner
Practice locations: Palm Harbor, FL

National Provider Directory

National Provider Directory
Part of
Gerardo P Sison Jr MD

Locations

34650 US Highway 19 N
Ste 107
Palm Harbor, FL 34684
Phone (727) 787-3422

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1962678110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34650 US HIGHWAY 19 N",
            "address_2": "SUITE 107",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346842155",
            "telephone_number": "727-787-3422",
            "fax_number": "727-787-5624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34650 US HIGHWAY 19 N",
            "address_2": "SUITE 107",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346842155",
            "telephone_number": "727-787-3422",
            "fax_number": "727-787-5624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERARDO P. SISON, JR., M.D., P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GERARDO P. SISON, JR., M.D.. P.A.",
        "enumeration_date": "2008-05-07",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "SISON",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "727-787-3422",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME53725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "064334300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Harbor, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; 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.