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COUNTRYSIDE NEUROLOGY INC
NPI 1588834964
Psychiatry & Neurology - Neurology in Clearwater, FL

Active since March 03, 2008CLIA 10D1107768 · Waiver
2349 SUNSET POINT RD STE 403, CLEARWATER, FL 33765(727) 712-1567 Get Directions Write a Review

NPPES record last updated: March 3, 2008. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Countryside Neurology Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COUNTRYSIDE NEUROLOGY INC (NPI 1588834964) is a healthcare organization registered as a neurology in Clearwater, Florida and active in the NPI registry since March 2008. The organization holds a CLIA Waiver certificate valid through December 10, 2027 and lists Ardeshir Khademi-kemanshahi, President, as its authorized official.

NPPES Registry Identity

NPI1588834964
Entity TypeOrganization
Primary Taxonomy2084N0400X
Legal Business NameCOUNTRYSIDE NEUROLOGY INC
Location Address2349 SUNSET POINT RD STE 403Clearwater, FL 33765-1439
Mailing Address2349 Sunset Pt Rd Suite 403Clearwater, FL 34682 · (727) 712-1567
Phone(727) 712-1567
Organization SubpartNo
Authorized OfficialArdeshir Khademi-kemanshahiPresident · (727) 712-1567
Enumeration DateMarch 3, 2008
✔ NPI 1588834964 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
License✔ Licensed in FL · ME80114
Definition
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
2349 SUNSET POINT RD STE 403, Clearwater, FL 33765
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Other Identifiers 1

Medicare PINK6108FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Countryside Neurology Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Countryside Neurology Inc, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Ardeshir Khademi-Kermanshahi, MD
Neurology
NPI 1861585903
1840 MEASE DR SUITE 407B
Safety Harbor, FL 34695
(727) 712-1567
✔ PECOS✔ Accepts Medicare4.0 mi
Collin Curry
Nurse Practitioner
NPI 1487269957
2301 HOLMES ST
Kansas City, MO 64108
(816) 404-3995
✔ PECOS✔ Accepts Medicare1,023 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D1107768

Countryside Neurology, Inc · Palm Harbor, FL
Active · expires Dec 10, 2027
CLIA Number10D1107768
Laboratory TypePhysician Office
Certificate Effective DateDecember 11, 2025
Certificate Expiration DateDecember 10, 2027
Laboratory DirectorArdeshir Khademi
Laboratory Phone(727) 712-1567
Laboratory LocationCountryside Neurology, Inc2595 Tampa Rd Suite V-W, Palm Harbor, FL 34684
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Countryside Neurology Inc's NPI number?

The NPI number for Countryside Neurology Inc is 1588834964. It was assigned to this organization in the NPPES registry on March 3, 2008.

Where is Countryside Neurology Inc located?

Countryside Neurology Inc is located at 2349 Sunset Point Rd Ste 403, Clearwater, FL 33765. The listed phone number is (727) 712-1567.

What is Countryside Neurology Inc's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

Is Countryside Neurology Inc enrolled in Medicare?

Yes. Countryside Neurology Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Countryside Neurology Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Countryside Neurology Inc, in Neurology and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Countryside Neurology Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1107768) is associated with this NPI, valid through December 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Countryside Neurology Inc accept?

Health plans from AvMed list Countryside Neurology Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Countryside Neurology Inc was last updated on March 3, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.