Active NPI
Derly Jean-Noel
- General Acute Care Hospital
- Kissimmee, FL
National Provider Identifier
1013360395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Acute Care Hospital
- License
- 4450
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| ME 94731 | FL | MD | Internal Medicine Physician |
| 4450 | FL | MD | General Acute Care Hospital |
| AG0316099 | FL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Florida Primary Care P L C | Current | Accepting new patients | |
| Orlando Health, Inc. | General Acute Care Hospital | Current | Accepting new patients |
| Astha Health | Current | 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
- https://fhir4.healow.com/fhir/r4/IAJGCA
- 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.
-
- Hospitalist Physician
- Kissimmee, FL
- NPI 1619611241
-
- Internal Medicine Physician
- Orlando, FL
- NPI 1609059666
-
- General Acute Care Hospital
- Orlando, FL
- NPI 1184709057
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.