NPIMap

Individual provider Active NPI

Dagoberto De la Vega, MD

  • Internal Medicine Physician
  • Miami, FL
National Provider Identifier
1114979671
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME67856 Issued in FL
Practice address
3200 SW 128TH Ave
Miami, FL 33175-2504
Phone
(305) 298-9100
Fax
(305) 274-0692
NPI assigned
May 16, 2006
Last updated
Feb 19, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME67856 FL Primary

Addresses

Primary practice location

3200 SW 128TH Ave
Miami, FL 33175-2504

Mailing address

3200 SW 128TH Ave
Miami, FL 33175-2504
Phone (305) 298-9100

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
I20050324000042 FL Practitioner - Internal MedicinePractitioner - General Practice 8527013762 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

11093 NW 138TH St
Suite 112
Hialeah Gardens, FL 33018-1153
Phone (305) 552-0303

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
D de la Vega MD P a Internal Medicine CurrentSince Aug 9, 1996 Accepting new patients
De la Vega Medical Center, LLC CurrentSince Jun 18, 2018 Accepting new patients
North American Medical Group LLC Internal Medicine Past Accepting new patients

Locations

11093 NW 138th St
Unit 121
Hialeah Gardens, FL 33018
Phone (786) 600-4040

11093 NW 138th St
Unit 112
Hialeah Gdns, FL 33018
Phone (305) 552-0303

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1114979671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 SW 128TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331752504",
            "telephone_number": "305-298-9100",
            "fax_number": "305-274-0692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 SW 128TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331752504",
            "telephone_number": "305-298-9100",
            "fax_number": "305-274-0692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA VEGA",
        "first_name": "DAGOBERTO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME67856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.