Individual provider Active NPI

Manuel Omar Cruz-Diaz

  • Pediatric Urology Physician
  • Orlando, FL
National Provider Identifier
1164696118
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
ME117509 Issued in FL
Practice address
258 S Chickasaw TRL Ste 202
Orlando, FL 32825-3501
Phone
(407) 303-6865
NPI assigned
Apr 21, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology Physician 2088P0231X Q1584 TX
General Practice Physician 208D00000X 18056 PR
Pediatric Urology Physician 2088P0231X ME117509 FL Primary

Addresses

Primary practice location

258 S Chickasaw TRL Ste 202
Orlando, FL 32825-3501

Mailing address

258 S Chickasaw TRL Ste 202
Orlando, FL 32825-3501
Phone (407) 303-6865

Other practice location 1

13535 Nemours Pkwy
Orlando, FL 32827-7402
Phone (407) 650-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20141122000106 TX Practitioner - UrologyPractitioner - Pediatric Medicine 3476875782 Reassigns benefits to 1 organization
I20211111001707 FL Practitioner - Urology 3476875782 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Puerto Rico School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME117509FLMDPediatric Urology Physician
18056PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc General Practice CurrentSince Mar 25, 2024 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Mar 25, 2024 Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

258 S Chickasaw Trl
Ste 202
Orlando, FL 32825
Phone (407) 303-6865

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: ocruzdiaz77778@direct.nemours.org
  • Direct secure messaging: mcruzdiaz2462911@adventhealth.direct-ci.com

Organizations & group practices 4

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": "1208736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1164696118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 S CHICKASAW TRL STE 202",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328253501",
            "telephone_number": "407-303-6865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 S CHICKASAW TRL STE 202",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328253501",
            "telephone_number": "407-303-6865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13535 Nemours Pkwy",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328277402",
            "country_code": "US",
            "telephone_number": "407-650-7000",
            "fax_number": "407-567-5924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRUZ-DIAZ",
        "first_name": "MANUEL",
        "middle_name": "OMAR",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-21",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "TX",
            "license": "Q1584",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "18056",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "FL",
            "license": "ME117509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.