Individual provider Active NPI

Lamar Ricardo Wedderburn, DO

  • Internal Medicine Physician
  • Orlando, FL
National Provider Identifier
1053802439
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS17834 Issued in FL
Practice address
1812 N Mills Ave
Orlando, FL 32803-1834
Phone
(407) 897-3499
NPI assigned
May 22, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OP61628433 WA
Internal Medicine Physician 207R00000X OS17834 FL Primary

Addresses

Primary practice location

1812 N Mills Ave
Orlando, FL 32803-1834

Mailing address

1812 N Mills Ave
Orlando, FL 32803-1834
Phone (407) 897-3499

Other practice location 1

7125 Murrell Rd Ste B
Melbourne, FL 32940-7999
Phone (321) 361-5585

Other practice location 2

8609 Evergreen Way
Everett, WA 98208
Phone (425) 789-3700

Other identifiers 2

IdentifierTypeStateIssuer
112929500MedicaidFL
N7997OtherFLFL MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210818000469 FL Practitioner - Internal Medicine 9739430406 Reassigns benefits to 1 organization
I20250501002583 WA Practitioner - Internal Medicine 9739430406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
William Carey University College of Osteopathic Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

1812 N Mills Ave
Orlando, FL 32803-1834
Phone (407) 897-3499

25 S Terry Ave
Suite 320
Orlando, FL 32805-1843
Phone (844) 407-4070

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

Hospital & facility affiliations

  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS17834FLMDInternal Medicine Physician
OP61628433WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Internal Medicine CurrentSince Aug 11, 2025 Accepting new patients
Community Health Center of Snohomish County CurrentSince Mar 6, 2025 Accepting new patients
Community Health Center of Snohomish County CurrentSince Mar 6, 2025 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Aug 11, 2025 Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

1812 N Mills Ave
Orlando, FL 32803
Phone (407) 897-3499

1019 112th St SW
Everett, WA 98204
Phone (425) 551-6001

8609 Evergreen Way
Everett, WA 98208
Phone (425) 551-6200

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: lwedderburn4382416@adventhealth.direct-ci.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 2

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": "1526947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1053802439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 N MILLS AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031834",
            "telephone_number": "407-897-3499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 N MILLS AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031834",
            "telephone_number": "407-897-3499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7125 Murrell Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329407999",
            "country_code": "US",
            "telephone_number": "321-361-5585",
            "fax_number": "321-253-3805",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8609 Evergreen Way",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "98208",
            "country_code": "US",
            "telephone_number": "425-789-3700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEDDERBURN",
        "first_name": "LAMAR",
        "middle_name": "RICARDO",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-22",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "OP61628433",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS17834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112929500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL MEDICARE",
            "identifier": "N7997",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.