Main Street Medical LLC
NPI 1487079505 · Primary Care Clinic/Center · Tampa, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1487079505
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Stephen Banjoko, Cfo(212) 257-0225
Specialties & taxonomies
Ambulatory Health Care Facilities
- Adult Medicine Physician207QA0505X
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
- Psychiatry Physician2084P0800X
Allopathic & Osteopathic Physicians
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Main Street Medical Centers
Additional practice locations (1)
- 6506 Embassy BlvdPort Richey, FL 34668-4734Phone: (727) 387-8228Fax: (727) 387-8020
Registry dates
- Enumerated
- 2014-02-26
- Last updated
- 2024-10-03
- Certified
- 2024-10-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.