| Ddsom | |
|
4502 Cortez Rd W Ste 204 Bradenton FL 34210-3124 | |
| (941) 761-1800 | |
| Not Available |
| Full Name | Ddsom |
|---|---|
| Speciality | Internal Medicine |
| Location | 4502 Cortez Rd W Ste 204, Bradenton, Florida |
| Authorized Official Name and Position | Rimantas Zalepuga (MEMBER) |
| Authorized Official Contact | 9417611800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ddsom Po Box 15089 Bradenton FL 34280-5089 Ph: (941) 761-1800 | Ddsom 4502 Cortez Rd W Ste 204 Bradenton FL 34210-3124 Ph: (941) 761-1800 |
| NPI Number | 1174655211 |
|---|---|
| Provider Enumeration Date | 03/12/2007 |
| Last Update Date | 08/11/2021 |
| Medicare PECOS PAC ID | 1951387158 |
|---|---|
| Medicare Enrollment ID | O20040628001253 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174655211 | NPI | - | NPPES |
| DC1249 | Other | FL | RAIL ROAD MEDICARE |
| 6102336 | Other | FL | CIGNA |
| 271367500 | Medicaid | FL | |
| 74735 | Other | FL | BCBS |
| 9751349 | Other | FL | GHI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | ME85682 (Florida) | Primary |
| Provider Name | Rimantas Zalepuga |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1316977499 PECOS PAC ID: 7517943723 Enrollment ID: I20040628001453 |
| Provider Name | Bruce W Trotman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1821093576 PECOS PAC ID: 6305824285 Enrollment ID: I20040708000372 |
| Provider Name | Silvio S. Tanev |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1093745341 PECOS PAC ID: 1658384169 Enrollment ID: I20060731000411 |
| Provider Name | Staci Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982821757 PECOS PAC ID: 8325121999 Enrollment ID: I20080206000287 |
| Provider Name | Sara Aileen Regino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497389050 PECOS PAC ID: 8426479429 Enrollment ID: I20200529001393 |
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