Individual provider Active NPI

Mary Theresa Elengical, D.O.

  • Anesthesiology Physician
  • Tavares, FL
National Provider Identifier
1275799637
Registry record updated Jan 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
OS11134 Issued in FL
Practice address
1000 Waterman Way
Department of Anesthesia
Tavares, FL 32778-5266
Phone
(352) 253-3333
NPI assigned
Aug 5, 2008
Last updated
Jan 6, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X OS11134 FL Primary
Anesthesiology Physician 207L00000X 125052315 IL

Addresses

Primary practice location

1000 Waterman Way
Department of Anesthesia
Tavares, FL 32778-5266

Mailing address

PO Box 3130
Ocala, FL 34478-3130
Phone (352) 867-8311

Other identifiers 2

IdentifierTypeStateIssuer
14A6MOtherFLBCBS OF FLORIDA
002939300MedicaidFL

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
I20110103000738 FL Practitioner - Anesthesiology 4486842630 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sheridan Healthcorp IncGroup PAC ID 3173429693, 956 clinicians

Practice addresses (Care Compare)

2815 S Seacrest Blvd
Boynton Beach, FL 33435-7969
Phone (561) 737-7733

401 NW 42ND Ave
Plantation, FL 33317-2835
Phone (954) 587-5010

9655 Boynton Beach Blvd
Boynton Beach, FL 33472-4421
Phone (561) 336-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125052315ILMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sheridan Healthcorp, Inc. Anesthesiology CurrentSince Jul 1, 2013 Accepting new patients
Sheridan Healthcorp Inc Anesthesiology Current Accepting new patients
Sheridan Healthcorp Inc Anesthesiology CurrentSince Jul 1, 2013 Accepting new patients

Locations

9655 Boynton Beach Blvd
Boynton Beach, FL 33472
Phone (561) 336-7000

401 NW 42nd Ave
Plantation, FL 33317
Phone (954) 513-6434

1613 NW 136th Ave
Ste 200
Sunrise, FL 33323
Phone (954) 838-2502

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294272000000",
    "number": "1275799637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3130",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344783130",
            "telephone_number": "352-867-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 WATERMAN WAY",
            "address_2": "DEPARTMENT OF ANESTHESIA",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327785266",
            "telephone_number": "352-253-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELENGICAL",
        "first_name": "MARY",
        "middle_name": "THERESA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-05",
        "last_updated": "2011-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "OS11134",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "125052315",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "14A6M",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002939300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tavares, FL

Sources for this page

Verify at the official NPI Registry.