NPIMap

Organization Active NPI

Central Florida Pathology Associates PA

  • Anatomic Pathology & Clinical Pathology Physician
  • Orlando, FL
National Provider Identifier
1255313664
Registry record updated Jan 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
CENTRAL FLORIDA PATHOLOGY ASSOCIATES PA
Practice address
601 E Rollins St
Dept. of Pathology
Orlando, FL 32803-1248
Phone
(404) 303-6611
NPI assigned
Nov 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2012

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

Authorized official

Name
Robert L Randell, M.D.NPI 1396727723
Title
President
Phone
(407) 303-6611

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
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

601 E Rollins St
Dept. of Pathology
Orlando, FL 32803-1248

Mailing address

PO Box 140987
Orlando, FL 32814-0987
Phone (407) 422-9831

Other identifiers 2

IdentifierTypeStateIssuer
CN6381OtherRAILROAD MEDICARE
253421500MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100303001060 FL Part B Supplier - Clinic/Group Practice 7810030061 Receives reassigned benefits from 32 practitioners
Practice locations: Altamonte Springs, FL; Winter Park, FL; Titusville, FL; Palm Bay, FL; Orlando, FL; New Smyrna Beach, FL; Merritt Island, FL; Melbourne, FL…

National Provider Directory

National Provider Directory

Locations

1264 Malabar Rd SE
Palm Bay, FL 32907
Phone (321) 434-8216

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1132358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326672000000",
    "number": "1255313664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 140987",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328140987",
            "telephone_number": "407-422-9831",
            "fax_number": "407-648-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E ROLLINS ST",
            "address_2": "DEPT. OF PATHOLOGY",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031248",
            "telephone_number": "404-303-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL FLORIDA PATHOLOGY ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-19",
        "last_updated": "2012-01-16",
        "status": "A",
        "authorized_official_last_name": "RANDELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-303-6611",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN6381",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253421500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.