Active NPI
Wayne M Nevala, M.D.
- Emergency Medicine Physician
- Tavares, FL
National Provider Identifier
1194713289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- O34426
- Practice address
- 1000 Waterman Way
Tavares, FL 32778-5266 - Phone
- (352) 253-3333
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | O34426 | GA | Primary |
Addresses
Primary practice location
1000 Waterman Way
Tavares, FL 32778-5266
Mailing address
500 Winderley PL
Suite 115
Maitland, FL 32751-7247
Phone (404) 875-8784
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00828055J | Medicaid | GA | |
| 262759100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O34426 | GA | MD | Emergency Medicine Physician |
| 22173 | CT | MD | Reproductive Endocrinology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Observation Medicine Specialists LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Maitland, FL
- NPI 1134596893
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194713289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 WINDERLEY PL",
"address_2": "SUITE 115",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327517247",
"telephone_number": "404-875-8784",
"fax_number": "404-875-0244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 WATERMAN WAY",
"city": "TAVARES",
"state": "FL",
"postal_code": "327785266",
"telephone_number": "352-253-3333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEVALA",
"first_name": "WAYNE",
"middle_name": "M",
"name_prefix": "Miss",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "GA",
"license": "O34426",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00828055J",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "262759100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tavares, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.