Individual provider Active NPI

Marissa C Perez, AUD

  • Audiologist
  • Orlando, FL
National Provider Identifier
1134402829
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AY1674 Issued in FL
Practice address
50 Sturtevant St
Orlando, FL 32806-2022
Phone
(321) 841-6144
NPI assigned
Sep 20, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AY1674 FL Primary

Addresses

Primary practice location

50 Sturtevant St
Orlando, FL 32806-2022

Mailing address

50 Sturtevant St
Orlando, FL 32806-2022
Phone (321) 841-6144

Other practice location 1

50 West Sturtevant Street
Orlando, FL 32806
Phone (321) 841-6144

Other identifiers 1

IdentifierTypeStateIssuer
123793300MedicaidFL

Other names 1

  • Dr. Marissa C Rosa Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240905003736 FL Practitioner - Qualified Audiologist 9638619505 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Sep 1, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Sep 1, 2024 Accepting new patients

Locations

1414 Kuhl Ave
Orlando, FL 32806
Phone (407) 464-9516

50 Sturtevant St
Orlando, FL 32806
Phone (321) 841-6144

92 W Miller St
Orlando, FL 32806
Phone (321) 841-4607

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1134402829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 STURTEVANT ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062022",
            "telephone_number": "321-841-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 STURTEVANT ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062022",
            "telephone_number": "321-841-6144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 West Sturtevant Street",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "32806",
            "country_code": "US",
            "telephone_number": "321-841-6144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "MARISSA",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-20",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "FL",
            "license": "AY1674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123793300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "ROSA",
            "middle_name": "C",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.