Individual provider Active NPI

Javier Urdaneta, MD

  • Family Medicine Physician
  • Oviedo, FL
National Provider Identifier
1063499119
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME68802 Issued in FL
Practice address
5414 Deep Lake Rd Ste 1104
Oviedo, FL 32765-5243
Phone
(407) 986-9850
Fax
(844) 388-6186
NPI assigned
Dec 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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 ME68802 FL Primary

Addresses

Primary practice location

5414 Deep Lake Rd Ste 1104
Oviedo, FL 32765-5243

Mailing address

601 S Harbour Island Blvd Ste 200
Tampa, FL 33602-5925
Phone (727) 322-3439

Other identifiers 1

IdentifierTypeStateIssuer
378071600MedicaidFL

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
I20040810000787 FL Practitioner - Family Practice 1658343603 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Florida Medical Associates LLCGroup PAC ID 0648271155, 162 clinicians

Practice addresses (Care Compare)

1442 W 1St St
Sanford, FL 32771-1647
Phone (407) 878-1734

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Medical Associates LLC CurrentSince Mar 1, 2019 Accepting new patients
Vipcare Dental PLLC PastSince Mar 1, 2019 Accepting new patients
Centerwell Senior Primary Care (FL) Inc. Family Medicine PastSince Mar 20, 2007 Accepting new patients

Locations

13940 N US Highway 441
Ste 102
Lady Lake, FL 32159
Phone (352) 509-9900

5626 Curry Ford Rd
Orlando, FL 32822
Phone (407) 985-5677

5414 Deep Lake Rd
Ste 1104
Oviedo, FL 32765
Phone (407) 986-9850

4600 Mobile Hwy
#10
Pensacola, FL 32506
Phone (850) 407-4997

1442 W 1st St
Sanford, FL 32771
Phone (352) 306-0062

601 S Harbour Island Blvd
Ste 200
Tampa, FL 33602
Phone (727) 322-3439

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: javier.urdaneta@sl.eclinicaldirectplus.com

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.

Hospital & facility affiliations 4

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": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1063499119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S HARBOUR ISLAND BLVD STE 200",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336025925",
            "telephone_number": "727-322-3439",
            "fax_number": "800-928-7449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5414 DEEP LAKE RD STE 1104",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327655243",
            "telephone_number": "407-986-9850",
            "fax_number": "844-388-6186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "URDANETA",
        "first_name": "JAVIER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME68802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378071600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oviedo, FL

Sources for this page

Verify at the official NPI Registry.