Individual provider Active NPI

Mirta M. Mederos-Lezcano, MD

  • Anesthesiology Physician
  • Plantation, FL
National Provider Identifier
1164495289
Registry record updated Mar 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
ME64316 Issued in FL
Practice address
7700 W Sunrise Blvd # 200
Plantation, FL 33322-4113
Phone
(954) 838-2371
NPI assigned
Feb 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X ME64316 FL Primary

Addresses

Primary practice location

7700 W Sunrise Blvd # 200
Plantation, FL 33322-4113

Mailing address

PO Box 817737
Hollywood, FL 33081-1737

Other identifiers 1

IdentifierTypeStateIssuer
262363300MedicaidFL

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address mmederoslezcano12210@mhsdirect.net
Direct Messaging Address mmederoslezcano12210@mhsdirect.net
Direct Messaging Address mmederoslezcano12210@mhsdirect.net

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
I20070608000104 FL Practitioner - Anesthesiology 7911005301 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Ponce School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sheridan Healthcorp IncGroup PAC ID 3173429693, 956 clinicians

Practice addresses (Care Compare)

401 NW 42ND Ave
Plantation, FL 33317-2835
Phone (954) 587-5010

703 N Flamingo Rd
Pembroke Pines, FL 33028-1006
Phone (954) 844-7137

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sheridan Healthcorp, Inc Anesthesiology CurrentSince Oct 26, 2006 Accepting new patients
Sheridan Healthcorp Inc Anesthesiology Current Accepting new patients
Sheridan Healthcorp, Inc. Anesthesiology CurrentSince Oct 26, 2006 Accepting new patients

Locations

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

3501 Johnson St
Pembroke Park, FL 33021
Phone (954) 265-2000

501 N Flamingo Rd
Pembroke Pnes, FL 33028
Phone (954) 430-1700

401 NW 42nd Ave
Plantation, FL 33317
Phone (954) 513-6434

1613 NW 136th Ave
Ste 200
Sunrise, FL 33323
Phone (954) 838-2502

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1164495289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 817737",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330811737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 W SUNRISE BLVD # 200",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333224113",
            "telephone_number": "954-838-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEROS-LEZCANO",
        "first_name": "MIRTA",
        "middle_name": "M.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-09",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME64316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "262363300",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmederoslezcano12210@mhsdirect.net",
            "affiliation": "N",
            "address_1": "7700 W Sunrise Blvd # 200",
            "city": "Plantation",
            "state": "FL",
            "country_code": "US",
            "postal_code": "333224113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmederoslezcano12210@mhsdirect.net",
            "affiliation": "N",
            "address_1": "7700 W Sunrise Blvd # 200",
            "city": "Plantation",
            "state": "FL",
            "country_code": "US",
            "postal_code": "333224113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmederoslezcano12210@mhsdirect.net",
            "affiliation": "N",
            "address_1": "7700 W Sunrise Blvd # 200",
            "city": "Plantation",
            "state": "FL",
            "country_code": "US",
            "postal_code": "333224113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

Verify at the official NPI Registry.