Individual provider Active NPI

Mohit Jain, MD

  • Family Medicine Physician
  • Longwood, FL
National Provider Identifier
1043334543
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME101833 Issued in FL
Practice address
515 W State Road 434 Ste 110
Longwood, FL 32750-5161
Phone
(407) 830-8600
Fax
(407) 830-5110
NPI assigned
Mar 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME101833 FL Primary

Addresses

Primary practice location

515 W State Road 434 Ste 110
Longwood, FL 32750-5161

Mailing address

515 W State Road 434 Ste 110
Longwood, FL 32750-5161
Phone (407) 830-8600

Other identifiers 1

IdentifierTypeStateIssuer
000351400MedicaidFL

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
I20110816000597 FL Practitioner - Family Practice 3870677727 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optumcare Florida, LLCGroup PAC ID 3072403476, 266 clinicians

Practice addresses (Care Compare)

515 W State Rd 434
110 Optum South Seminole
Longwood, FL 32750-5161
Phone (407) 830-8600

Hospital & facility affiliations

  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
  • Deaconess Medical Center Hospital, Spokane, WA, CCN 500044

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare Florida, LLC CurrentSince Jan 1, 2014 Accepting new patients
Optumcare Florida LLC Family Medicine CurrentSince Jan 1, 2014 Accepting new patients
Optumcare Florida Ci, LLC Past Accepting new patients
Community Memorial Hospital Past Accepting new patients

Locations

1345 West Bay Dr
Ste 202
Largo, FL 33770
Phone (727) 559-0895

515 W State Road 434
Ste 110
Longwood, FL 32750
Phone (407) 645-2661

1718 Lexington Green Ln
Sanford, FL 32771
Phone (407) 268-9661

10051 5th St N
Ste 200
St Petersburg, FL 33702
Phone (727) 286-4093

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: mohit.jain@wellmed.eclinicaldirectplus.com

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1043334543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 W STATE ROAD 434 STE 110",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505161",
            "telephone_number": "407-830-8600",
            "fax_number": "407-830-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 W STATE ROAD 434 STE 110",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505161",
            "telephone_number": "407-830-8600",
            "fax_number": "407-830-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "MOHIT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME101833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000351400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longwood, FL

Sources for this page

Verify at the official NPI Registry.