NPIMap

Individual provider Active NPI

Agustin Vanoni, M.D

  • General Practice Physician
  • Lakeland, FL
National Provider Identifier
1144561184
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN1315 Issued in FL
Practice address
4729 US Highway 98 S
Lakeland, FL 33812-4323
Phone
(863) 646-9663
NPI assigned
Mar 14, 2013
Last updated
Apr 1, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 19588 PR
General Practice Physician 208D00000X ACN1315 FL Primary

Addresses

Primary practice location

4729 US Highway 98 S
Lakeland, FL 33812-4323

Mailing address

6675 Westwood Blvd
Ste 475
Orlando, FL 32821-6027
Phone (407) 845-0384

Other practice location 1

4120 US Highway 98 N
Lakeland, FL 33809-3854
Phone (863) 940-3147

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180123003254 PR Practitioner - General Practice 4688933401 Reassigns benefits to 1 organization
Practice locations: Aibonito, PR
I20210514002457 FL Practitioner - General Practice 4688933401 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Home Alliance, LLCGroup PAC ID 6406096536, 60 clinicians

Practice addresses (Care Compare)

4729 US Hwy 98 S
Suite 201
Lakeland, FL 33812-4336
Phone (863) 646-9663

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ACN1315FLMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Home Alliance LLC CurrentSince Dec 10, 2023 Accepting new patients
Mennonite General Hospital Inc. CurrentSince May 22, 2019 Accepting new patients
Medical Home Alliance LLC CurrentSince May 6, 2021 Accepting new patients
Mennonite General Hospital Inc CurrentSince May 22, 2019 Accepting new patients
Medical Home Alliance LLC Past Accepting new patients

Locations

4120 US Highway 98 N
Ste 200
Lakeland, FL 33809
Phone (863) 853-7822

4729 US Highway 98 S
Ste 201
Lakeland, FL 33812
Phone (863) 646-9663

6675 Westwood Blvd
Ste 475
Orlando, FL 32821
Phone (407) 845-0384

199 Avenue K SE
Winter Haven, FL 33880
Phone (563) 588-1424

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 5

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 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": "1363219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1144561184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6675 WESTWOOD BLVD",
            "address_2": "STE 475",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328216027",
            "telephone_number": "407-845-0384",
            "fax_number": "888-972-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4729 US HIGHWAY 98 S",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338124323",
            "telephone_number": "863-646-9663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4120 US Highway 98 N",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338093854",
            "country_code": "US",
            "telephone_number": "863-940-3147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANONI",
        "first_name": "AGUSTIN",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-14",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "19588",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.