Individual provider Active NPI

Ronald Richard Domescek, M.D.

  • Interventional Cardiology Physician
  • Orlando, FL
National Provider Identifier
1013912948
Registry record updated Nov 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
ME57239 Issued in FL
Practice address
1222 S Orange Ave
Orlando, FL 32806-1215
Phone
(407) 650-1300
Fax
(407) 650-1307
NPI assigned
Jun 16, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X ME57239 FL
Interventional Cardiology Physician 207RI0011X ME57239 FL Primary

Addresses

Primary practice location

1222 S Orange Ave
Orlando, FL 32806-1215

Mailing address

1222 S Orange Ave
Orlando, FL 32806-1215
Phone (407) 650-1300

Other identifiers 2

IdentifierTypeStateIssuer
063394100MedicaidFL
ME57239OtherFLMEDICAL LICENSE

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100317000643 FL Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 3870497142 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc Cardiovascular Disease CurrentSince Sep 1, 2011 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Sep 1, 2011 Accepting new patients
Cardiology Assoc of Orlando Orlando Heart Center Cardiovascular Disease PastSince Aug 1, 1990 Accepting new patients

Locations

60 W Gore St
Orlando, FL 32806
Phone (321) 841-3338

1414 Kuhl Ave
Orlando, FL 32806
Phone (407) 464-9516

1222 S Orange Ave
Orlando, FL 32806
Phone (407) 649-6907

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

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": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478822400000",
    "number": "1013912948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061215",
            "telephone_number": "407-650-1300",
            "fax_number": "407-650-1307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061215",
            "telephone_number": "407-650-1300",
            "fax_number": "407-650-1307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMESCEK",
        "first_name": "RONALD",
        "middle_name": "RICHARD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2016-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME57239",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME57239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063394100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME57239",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.