Ebenezer Medical Center Orlando Corp.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

EBENEZER MEDICAL CENTER ORLANDO CORP.

Practice address

845 E Oak Street
Kissimmee, FL 34744-5838

Phone

(407) 343-1278

Fax

(888) 498-3604

NPI assigned

May 12, 2022

Organization subpart

No

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

Authorized official

Name

Maite Jimenez

Title

Owner

Phone

(305) 491-3969

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

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

Practitioners 5

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

• Daniel Rafael Herrera Infante Sr., APRN

  • Family Nurse Practitioner
  • Hialeah, FL
  • NPI 1316416340
  Medicare reassignment Care Compare group NPD
• Janice Ramos Colon, MD

  • General Practice Physician
  • Orlando, FL
  • NPI 1194999813
  Medicare reassignment Care Compare group NPD
• Souheil Moussly, MD

  • Internal Medicine Physician
  • Port Orange, FL
  • NPI 1063524577
  Medicare reassignment NPD
• Dayma Fernandez Sanchez

  • Behavior Technician
  • Miami, FL
  • NPI 1528659729
  NPD
• Yamilis Negron Rios, APRN

  • Family Nurse Practitioner
  • Kissimmee, FL
  • NPI 1518882786
  NPD (past)

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

{
    "created_epoch": "1652313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1265178131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 E OAK STREET",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347445838",
            "telephone_number": "407-343-1278",
            "fax_number": "888-498-3604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 E OAK STREET",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347445838",
            "telephone_number": "407-343-1278",
            "fax_number": "888-498-3604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER MEDICAL CENTER ORLANDO CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-12",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-18",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "MAITE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-491-3969"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eagle Peak Emergency Physicians LLC
• Earnest Emergency Physicians, LLC
• East Lake Acupuncture, LLC
• East West Medical Center Inc
• Ashley Michelle Easterbrook
• Erika Ebersole
• Angel Echevarria Jr.
• Michelle Echevarria
• Allison Marie Eckert
• Rosana Econg

• General Practice Physician in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; 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.