Individual provider Active NPI

Fabio Mariano Mehrgut, M.D.

  • Pediatrics Physician
  • Miami, FL
National Provider Identifier
1174504690
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME122911 Issued in FL
Practice address
16255 SW 83Rd LN
Miami, FL 33193-5133
Phone
(786) 479-7878
Fax
(305) 246-5880
NPI assigned
Nov 10, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 168071 NY
Pediatrics Physician 208000000X ME122911 FL Primary

Addresses

Primary practice location

16255 SW 83Rd LN
Miami, FL 33193-5133

Mailing address

16255 SW 83Rd Lane
Miami, FL 33193
Phone (786) 479-7878

Other identifiers 2

IdentifierTypeStateIssuer
012072258MedicaidNY
015562600MedicaidFL

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
I20201026001463 FL Practitioner - General PracticePractitioner - Internal Medicine 7012337348 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
168071NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Victoria M Medical Center Corp CurrentSince Mar 2, 2026 Accepting new patients
Open Doors Community Center Corp. CurrentSince Oct 5, 2021 Accepting new patients

Locations

2520 NW 97th Ave
Ste 3230
Doral, FL 33172
Phone (786) 534-4971

175 Fontainebleau Blvd
Ste 1D
Miami, FL 33172
Phone (786) 615-2609

Interoperability endpoints

  • Direct secure messaging: fabio.mehrgut@451.emedpractice.direct-ci.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1174504690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16255 SW 83RD LANE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33193",
            "telephone_number": "786-479-7878",
            "fax_number": "305-246-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16255 SW 83RD LN",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331935133",
            "telephone_number": "786-479-7878",
            "fax_number": "305-246-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHRGUT",
        "first_name": "FABIO",
        "middle_name": "MARIANO",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2021-08-18",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "168071",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME122911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012072258",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015562600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.