Active NPI
Mai Tran, MD
- Pediatrics Physician
- Fellsmere, FL
National Provider Identifier
1013121722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME104544
- Practice address
- 12196 County Road 512
Fellsmere, FL 32948-5463 - Phone
- (772) 257-8224
- Fax
- (772) 257-6575
- NPI assigned
- May 10, 2007
- Last updated
- Jul 11, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME104544 | FL | Primary |
Addresses
Primary practice location
12196 County Road 512
Fellsmere, FL 32948-5463
Mailing address
12196 County Road 512
Fellsmere, FL 32948-5463
Phone (772) 257-8224
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001430900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130430000608 | FL | Order and Referring Only - Pediatric Medicine | 7012154545 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341964800000",
"number": "1013121722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12196 COUNTY ROAD 512",
"city": "FELLSMERE",
"state": "FL",
"postal_code": "329485463",
"telephone_number": "772-257-8224",
"fax_number": "772-257-6575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12196 COUNTY ROAD 512",
"city": "FELLSMERE",
"state": "FL",
"postal_code": "329485463",
"telephone_number": "772-257-8224",
"fax_number": "772-257-6575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAN",
"first_name": "MAI",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-10",
"last_updated": "2012-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME104544",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001430900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fellsmere, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.