Individual provider Active NPI

Derly Jean-Noel

  • General Acute Care Hospital
  • Kissimmee, FL
National Provider Identifier
1013360395
Registry record updated Jul 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
4450 Issued in FL
Practice address
3380 Wilderness TRL
Kissimmee, FL 34746-2926
Phone
(407) 973-9432
NPI assigned
Jul 21, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME 94731 FL
General Acute Care Hospital 282N00000X 4450 FL Primary
Exclusive Provider Organization 302F00000X
Nurse Practitioner 363L00000X AG0316099 FL

Addresses

Primary practice location

3380 Wilderness TRL
Kissimmee, FL 34746-2926

Mailing address

3380 Wilderness TRL
Kissimmee, FL 34746-2926
Phone (407) 973-9432

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171016002573 FL Practitioner - Nurse Practitioner 8729354956 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Astha HealthGroup PAC ID 9931589892, 30 clinicians

Practice addresses (Care Compare)

804 Emmett St
Kissimmee, FL 34741-5434
Phone (407) 785-1111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ME 94731FLMDInternal Medicine Physician
4450FLMDGeneral Acute Care Hospital
AG0316099FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Florida Primary Care P L C CurrentSince Aug 6, 2017 Accepting new patients
Orlando Health, Inc. General Acute Care Hospital Current Accepting new patients
Astha Health CurrentSince Jun 1, 2022 Accepting new patients

Locations

804 Emmett St
Kissimmee, FL 34741
Phone (407) 449-4559

7345 W Sand Lake Rd
Ste 206
Orlando, FL 32819
Phone (407) 248-8862

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IAJGCA
  • Direct secure messaging: djeannoel178992@orlandohealth.medalliesdirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469059200000",
    "number": "1013360395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3380 WILDERNESS TRL",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347462926",
            "telephone_number": "407-973-9432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3380 WILDERNESS TRL",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347462926",
            "telephone_number": "407-973-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEAN-NOEL",
        "first_name": "DERLY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-21",
        "last_updated": "2016-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME 94731",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "FL",
            "license": "4450",
            "primary": true
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "AG0316099",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.