Luis Clyde Favilli, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME56610 Issued in FL

Practice address

3650 Innovation Dr
Lakeland, FL 33812-4105

Phone

(860) 709-1968

Fax

(863) 701-2151

NPI assigned

Jun 20, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Medical Home Alliance, LLCGroup PAC ID 6406096536, 60 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baycare Home Care Inc Home health agency, Lakeland, FL, CCN 107282
• Lakeland Regional Medical Center Hospital, Lakeland, FL, CCN 100157
• Winter Haven Hospital Hospital, Winter Haven, FL, CCN 100052

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• FL PPO
• Freedom Health HMO Network
• FL HMO
• Optimum HealthCare HMO Network

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BEJADA

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.

• Medical Home Alliance LLC

  • Internal Medicine Physician
  • Davenport, FL
  • NPI 1740527811
  Medicare reassignment Care Compare group NPD
• Medical Home Alliance LLC

  dba IMA Medical Group - South Lakeland

  • Internal Medicine Physician
  • Lakeland, FL
  • NPI 1134896004
  NPD
• Medical Home Alliance LLC

  dba IMA Winter Haven Dispensary

  • Non-Pharmacy Dispensing Site
  • Winter Haven, FL
  • NPI 1033648233
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baycare Home Care, Inc.

  • Home Health Agency
  • Bradenton, FL
  • NPI 1295728186
  Care Compare affiliation
• Baycare Home Care, Inc.

  • Home Health Agency
  • Lakeland, FL
  • NPI 1952309171
  Care Compare affiliation
• Lakeland Regional Medical Center, Inc.

  dba Lakeland Regional Medical Center

  • General Acute Care Hospital
  • Lakeland, FL
  • NPI 1144228446
  Care Compare affiliation
• Winter Haven Hospital Inc

  • General Acute Care Hospital
  • Winter Haven, FL
  • NPI 1477599975
  Care Compare affiliation

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1013912625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6675 WESTWOOD BLVD STE 475",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328216027",
            "telephone_number": "407-845-0330",
            "fax_number": "888-972-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 INNOVATION DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338124105",
            "telephone_number": "860-709-1968",
            "fax_number": "863-701-2151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAVILLI",
        "first_name": "LUIS",
        "middle_name": "CLYDE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME56610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "374563500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georgette Farmer, APRN
• Farmmosaic
• Muhammad Zain Farooq, MD
• Jennifer Lee Faucher-Patterson, PT
• Kimberly Favaro
• Kylie Fayad
• Yuliya Faynberg, OD
• Colton Austin Faza, M.D.
• Christine Fechter, ARNP-BC
• Ardit Feinaj, MD

• Family Medicine Physician in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; 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.

Verify at the official NPI Registry.