NPIMap

Individual provider Active NPI

Paul David Sovran, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Kissimme, FL
National Provider Identifier
1093710097
Registry record updated May 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
ME039107 Issued in FL
Practice address
211 East Ruby Ave
Kissimme, FL 34741-5679
Phone
(407) 847-3333
Fax
(407) 847-8622
NPI assigned
Jun 16, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME039107 FL
Geriatric Medicine (Internal Medicine) Physician 207RG0300X ME039107 FL Primary
Aerospace Medicine Physician 2083A0100X ME039107 FL

Addresses

Primary practice location

211 East Ruby Ave
Kissimme, FL 34741-5679

Mailing address

211 East Ruby Ave
Kissimme, FL 34741-5679
Phone (407) 847-3333

Other identifiers 1

IdentifierTypeStateIssuer
47471OtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110407000945 FL Practitioner - Geriatric MedicinePractitioner - Internal Medicine 4486838935 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
New York Medical College, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

211 Ruby Ave
Kissimmee, FL 34741-5679
Phone (407) 847-3333

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Orlando, FL, CCN 107234
  • Centerwell Home Health Home health agency, Winter Haven, FL, CCN 107534
  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007
  • HCA Florida Poinciana Hospital Hospital, Kissimmee, FL, CCN 100320
  • HCA Florida Osceola Hospital Hospital, Kissimmee, FL, CCN 100110

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME039107FLMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Paul D Sovran MD PA Geriatric Medicine CurrentSince Jun 28, 2010 Accepting new patients

Locations

211 Ruby Ave
#A
Kissimmee, FL 34741

211 Ruby Ave
Ste A
Kissimmee, FL 34741
Phone (407) 841-7151

211 Ruby Ave
Kissimmee, FL 34741
Phone (407) 847-3333

Interoperability endpoints

  • Direct secure messaging: psovran@paulsovranmd.amazing-direct.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/JCCCDD/Endpoint/JCCCDD

Organizations & group practices 1

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 7

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": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306454400000",
    "number": "1093710097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 EAST RUBY AVE",
            "city": "KISSIMME",
            "state": "FL",
            "postal_code": "347415679",
            "telephone_number": "407-847-3333",
            "fax_number": "407-847-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 EAST RUBY AVE",
            "city": "KISSIMME",
            "state": "FL",
            "postal_code": "347415679",
            "telephone_number": "407-847-3333",
            "fax_number": "407-847-8622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOVRAN",
        "first_name": "PAUL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2011-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME039107",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME039107",
            "primary": true
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "FL",
            "license": "ME039107",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "47471",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimme, FL

Sources for this page

Verify at the official NPI Registry.