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  7. NPI Record 1689347890

BAYCARE MEDICAL GROUP INC
Complete NPI Record 1689347890
Family Medicine in Lutz, FL

NPI Status: Active since July 26, 2021

Contact Information

4211 VAN DYKE RD STE 101B
LUTZ, FL
ZIP 33558
Phone: (813) 968-7171

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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 Enumeration Date
  17. Last Update Date
  18. Authorized Official Last Name
  19. Authorized Official First Name
  20. Authorized Official Title or Position
  21. Authorized Official Telephone Number
  22. Healthcare Provider Taxonomy Code 1
  23. Healthcare Provider Primary Taxonomy Switch 1
  24. Healthcare Provider Taxonomy Code 2
  25. Healthcare Provider Primary Taxonomy Switch 2
  26. Is Organization Subpart
  27. Healthcare Provider Taxonomy Group 1
  28. Healthcare Provider Taxonomy Group 2
  29. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1689347890. 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: 1689347890
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 2995 DREW ST FL 3
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: CLEARWATER
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: FL
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’’.
Provider Business Mailing Address Postal Code: 337593012
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’’.
Provider Business Mailing Address Country Code If outside U S : US
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’’.
Provider First Line Business Practice Location Address: 4211 VAN DYKE RD STE 101B
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 Practice Location Address City Name: LUTZ
The city name in 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: 335588005
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: 8139687171
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 7/26/2021
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/26/2021
The date that a record was last updated or changed.
Authorized Official Last Name: GORKEN
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’’.
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 postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Healthcare Provider Taxonomy Code 1: 207Q00000X
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: Y
Healthcare Provider Taxonomy Code 2: 207R00000X
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Primary Taxonomy Switch 2: N
Is Organization Subpart: N
Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Healthcare Provider Taxonomy Group 2: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
NPI Certification Date: 7/5/2021