Individual provider Active NPI

Daniel Carlos Mijares

  • Physician Assistant
  • Homestead, FL
National Provider Identifier
1033704580
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9113118 Issued in FL
Practice address
437 N Krome Ave
Homestead, FL 33030-6040
Phone
(786) 378-8277
Fax
(305) 328-4089
NPI assigned
Mar 6, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9113118 FL Primary

Addresses

Primary practice location

437 N Krome Ave
Homestead, FL 33030-6040

Mailing address

7700 SW 176TH St
Palmetto Bay, FL 33157-6244
Phone (786) 564-2670

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
I20230331000160 FL Practitioner - Physician Assistant 0143695353 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9113118FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Yesenia Medina DO PA Past Accepting new patients

Organizations & group practices 2

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": "1614988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1033704580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7700 SW 176TH ST",
            "city": "PALMETTO BAY",
            "state": "FL",
            "postal_code": "331576244",
            "telephone_number": "786-564-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 N KROME AVE",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330306040",
            "telephone_number": "786-378-8277",
            "fax_number": "305-328-4089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIJARES",
        "first_name": "DANIEL",
        "middle_name": "CARLOS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-06",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9113118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Homestead, FL

Sources for this page

Verify at the official NPI Registry.