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BAYCARE MEDICAL GROUP INC
Complete NPI Record 1275103624
Psychiatry & Neurology - Neurology in St Petersburg, FL

NPI Status: Active since June 29, 2021

Contact Information

1201 5TH AVE N STE 309
ST PETERSBURG, FL
ZIP 33705
Phone: (727) 824-3189
Fax: (727) 824-7101

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider First Line Business Practice Location Address
  11. Provider Business Practice Location Address City Name
  12. Provider Business Practice Location Address State Name
  13. Provider Business Practice Location Address Postal Code
  14. Provider Business Practice Location Address Country Code If outside U S
  15. Provider Business Practice Location Address Telephone Number
  16. Provider Business Practice Location Address Fax Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Authorized Official Last Name
  20. Authorized Official First Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Healthcare Provider Taxonomy Code 2
  26. Healthcare Provider Primary Taxonomy Switch 2
  27. Is Organization Subpart
  28. Healthcare Provider Taxonomy Group 1
  29. Healthcare Provider Taxonomy Group 2
  30. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1275103624. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1275103624
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Entity Type Code: 2
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Employer Identification Number EIN: UNAVAIL
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Mailing Address: 2995 DREW ST FL 3
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Business Mailing Address City Name: CLEARWATER
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Mailing Address State Name: FL
The city name in the location address of the provider being identified.
Provider Business Mailing Address Postal Code: 337593012
The State code in the location of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider First Line Business Practice Location Address: 1201 5TH AVE N STE 309
The country code in the location address of the provider being identified.
Provider Business Practice Location Address City Name: ST PETERSBURG
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address State Name: FL
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 337051425
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7278243189
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 7278247101
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 6/29/2021
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 6/29/2021
The date that a record was last updated or changed.
Authorized Official Last Name: GORKEN
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: LYNDA
The first name of the authorized official.
Authorized Official Title or Position: VP, PFS
The title or position of the authorized official.
Authorized Official Telephone Number: 7272819202
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 103G00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 2084N0400X
Healthcare Provider Primary Taxonomy Switch 2: Y
Is Organization Subpart: N
Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
NPI Certification Date: 6/29/2021