Individual provider Active NPI

Angel Enrique Llanio, D.O.

  • Family Medicine Physician
  • Palmetto, FL
National Provider Identifier
1174812564
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS11980 Issued in FL
Practice address
606 4TH Ave W
Palmetto, FL 34221-5226
Phone
(941) 722-7785
Fax
(941) 729-5267
NPI assigned
Apr 6, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS11980 FL Primary

Addresses

Primary practice location

606 4TH Ave W
Palmetto, FL 34221-5226

Mailing address

367 S. Gulph Rd
Att: Ipm Credentialing
King of Prussia, PA 19406-3121
Phone (775) 356-9393

Other identifiers 1

IdentifierTypeStateIssuer
011672000MedicaidFL

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
I20130627000573 FL Practitioner - Family PracticePractitioner - Obstetrics/Gynecology 6002056892 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carlos a Labrador Mdpa Family Medicine CurrentSince May 19, 2025 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Best Value Healthcare LLC PastSince Jun 22, 2021 Accepting new patients

Locations

6775 Crosswinds Dr N
St Petersburg, FL 33710
Phone (727) 381-8006

Networks

  • Freedom Health HMO Network

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": "1302048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1174812564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 S. GULPH RD",
            "address_2": "ATT: IPM CREDENTIALING",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194063121",
            "telephone_number": "775-356-9393",
            "fax_number": "775-356-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 4TH AVE W",
            "city": "PALMETTO",
            "state": "FL",
            "postal_code": "342215226",
            "telephone_number": "941-722-7785",
            "fax_number": "941-729-5267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LLANIO",
        "first_name": "ANGEL",
        "middle_name": "ENRIQUE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-06",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS11980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011672000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palmetto, FL

Sources for this page

Verify at the official NPI Registry.