NPIMap

Organization Active NPI

Regency Endocrinology, Diabetes and Metabolism, Inc.

  • Endocrinology, Diabetes & Metabolism Physician
  • Lake Mary, FL
National Provider Identifier
1215957741
Registry record updated Oct 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
0075530 Issued in FL
Legal business name
REGENCY ENDOCRINOLOGY, DIABETES AND METABOLISM, INC.
Practice address
752 Stirling Center PL
Suite 1008
Lake Mary, FL 32746-4889
Phone
(407) 333-1212
Fax
(407) 333-1213
NPI assigned
Jul 20, 2006
Last updated
Oct 10, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2013

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

Authorized official

Name
Maha F Ansara, M.D.NPI 1295754356
Title
President/Physician
Phone
(407) 333-1212

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 0075530 FL Primary

Addresses

Primary practice location

752 Stirling Center PL
Suite 1008
Lake Mary, FL 32746-4889

Mailing address

752 Stirling Center PL
Suite 1008
Lake Mary, FL 32746-4889
Phone (407) 333-1212

Other identifiers 2

IdentifierTypeStateIssuer
270616400MedicaidFL
74739OtherFLBCBS OF FLORIDA GROUP ID#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040629000156 FL Part B Supplier - Clinic/Group Practice 9931185014 Receives reassigned benefits from 16 practitioners
Practice locations: Lake Mary, FL; Lauderdale Lakes, FL; Boynton Beach, FL; Aventura, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0946804Regency Endocrinology Diabetes & Metabolism Inc752 Stirling Ctr PL Ste 1008, Lake Mary, FL 32746Certificate of waiverJun 2, 2028

National Provider Directory

National Provider Directory

Locations

752 Stirling Center Pl
Lake Mary, FL 32746
Phone (407) 333-1212

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AAEBDA

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381363200000",
    "number": "1215957741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "752 STIRLING CENTER PL",
            "address_2": "SUITE 1008",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327464889",
            "telephone_number": "407-333-1212",
            "fax_number": "407-333-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "752 STIRLING CENTER PL",
            "address_2": "SUITE 1008",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327464889",
            "telephone_number": "407-333-1212",
            "fax_number": "407-333-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENCY ENDOCRINOLOGY, DIABETES AND METABOLISM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2013-10-10",
        "status": "A",
        "authorized_official_last_name": "ANSARA",
        "authorized_official_first_name": "MAHA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "407-333-1212",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "FL",
            "license": "0075530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270616400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA GROUP ID#",
            "identifier": "74739",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.