Individual provider Active NPI

Nastasia Magda Douyon, M.D.

  • Internal Medicine Physician
  • Peoria, IL
National Provider Identifier
1235424151
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME126201 Issued in FL
Practice address
530 NE Glen Oak Ave BLDG 5607
Peoria, IL 61637-0001
Phone
(309) 655-3863
NPI assigned
Jun 20, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME126201 FL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave BLDG 5607
Peoria, IL 61637-0001

Mailing address

917 Rinehart Rd
Lake Mary, FL 32746-4802
Phone (407) 647-2346

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
I20160525002825 FL Practitioner - Internal Medicine 6800117755 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME126201FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Florida Inpatient Medicine LLC Internal Medicine CurrentSince Mar 20, 2016 Accepting new patients

Locations

917 Rinehart Rd
Ste 1051
Lake Mary, FL 32746
Phone (407) 562-9170

525 Technology Park
Ste 109
Lake Mary, FL 32746
Phone 4076472346 ext. 111

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461024000000",
    "number": "1235424151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 RINEHART RD",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327464802",
            "telephone_number": "407-647-2346",
            "fax_number": "407-647-2346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE BLDG 5607",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-3863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUYON",
        "first_name": "NASTASIA",
        "middle_name": "MAGDA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-20",
        "last_updated": "2016-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME126201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.