Individual provider Active NPI

Melissa Yolanda Mejia Disla, MD

  • Internal Medicine Physician
  • Orlando, FL
National Provider Identifier
1194952754
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME116099 Issued in FL
Practice address
690 S Goldenrod Rd
Orlando, FL 32822-8108
Phone
(407) 792-1144
Fax
(407) 232-9807
NPI assigned
Jun 22, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X ME116099 FL
Internal Medicine Physician 207R00000X ME116099 FL Primary

Addresses

Primary practice location

690 S Goldenrod Rd
Orlando, FL 32822-8108

Mailing address

690 S Goldenrod Rd
Orlando, FL 32822-8108
Phone (407) 792-1144

Other practice location 1

10250 SE 167th Place Rd
Suite 5-1
Summerfield, FL 34491-8686
Phone (352) 307-9925

Other practice location 2

10250 SE 167th Place Rd
Suite 5-1
Summerfield, FL 34491-8686
Phone (352) 307-9925

Other identifiers 1

IdentifierTypeStateIssuer
014155200MedicaidFL

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
I20140805000985 FL Practitioner - Internal MedicinePractitioner - Geriatric Medicine 4981821568 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Jul 1, 2020 Accepting new patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Jul 1, 2020 Accepting new patients
Manoogian Orthopedic Center, P.a. Past Accepting new patients
Broward Institute of Neuro Science L L C Past Accepting new patients

Locations

4715 S Florida Ave
Lakeland, FL 33813
Phone (863) 209-7003

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

690 S Goldenrod Rd
Orlando, FL 32822
Phone (407) 628-6117

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

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.

NPI Registry JSON

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

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1194952754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 S GOLDENROD RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328228108",
            "telephone_number": "407-792-1144",
            "fax_number": "407-232-9807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 S GOLDENROD RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328228108",
            "telephone_number": "407-792-1144",
            "fax_number": "407-232-9807"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10250 SE 167th Place Rd",
            "address_2": "Suite 5-1",
            "address_purpose": "LOCATION",
            "city": "Summerfield",
            "state": "FL",
            "postal_code": "344918686",
            "country_code": "US",
            "telephone_number": "352-307-9925",
            "fax_number": "352-304-8442",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10250 SE 167th Place Rd",
            "address_2": "Suite 5-1",
            "address_purpose": "LOCATION",
            "city": "Summerfield",
            "state": "FL",
            "postal_code": "344918686",
            "country_code": "US",
            "telephone_number": "352-307-9925",
            "fax_number": "352-304-8442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEJIA DISLA",
        "first_name": "MELISSA",
        "middle_name": "YOLANDA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-22",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME116099",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME116099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014155200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.