Individual provider Active NPI

Agustin Vega Santiago, M.D.

  • Internal Medicine Physician
  • Saint Cloud, FL
National Provider Identifier
1124322193
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME 127343 Issued in FL
Practice address
4691 Old Canoe Creek Rd
Saint Cloud, FL 34769-1550
Phone
(407) 498-4015
NPI assigned
Jan 5, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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 ME 127343 FL Primary
General Practice Physician 208D00000X 18052 PR

Addresses

Primary practice location

4691 Old Canoe Creek Rd
Saint Cloud, FL 34769-1550

Mailing address

4691 Old Canoe Creek Rd
Saint Cloud, FL 34769-1550
Phone (407) 498-4015

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
I20190201002413 FL Practitioner - Internal Medicine 1759668528 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inpatient Care Specialists LLCGroup PAC ID 0345493623, 101 clinicians
Central Florida Inpatient Medicine LLCGroup PAC ID 7911805254, 113 clinicians

Practice addresses (Care Compare)

525 Technology Park
Suite 109
Lake Mary, FL 32746-7107
Phone 4076472346111

Hospital & facility affiliations

  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 127343FLMDInternal Medicine Physician
18052PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ridgewood Physician Services, LLC CurrentSince Jan 7, 2019 Accepting new patients
Cogent Healthcare of Pensacola LLC Internal Medicine CurrentSince Jul 1, 2021 Accepting new patients
Central Florida Inpatient Medicine LLC Internal Medicine CurrentSince Sep 1, 2018 Accepting new patients
Cogent Healthcare of Pensacola LLC Internal Medicine CurrentSince Jul 1, 2021 Accepting new patients
Cogent Healthcare of Pensacola LLC Internal Medicine Current Accepting new patients

Locations

40100 Highway 27
Davenport, FL 33837
Phone (863) 419-2496

3625 University Blvd S
Jacksonville, FL 32216
Phone (904) 333-9404

525 Technology Park
Ste 109
Lake Mary, FL 32746
Phone 4076472346 ext. 111

1414 Kuhl Ave
#17
Orlando, FL 32806

Organizations & group practices 6

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": "1294185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1124322193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4691 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347691550",
            "telephone_number": "407-498-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4691 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347691550",
            "telephone_number": "407-498-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VEGA SANTIAGO",
        "first_name": "AGUSTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-05",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 127343",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "18052",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, FL

Sources for this page

Verify at the official NPI Registry.