NPIMap

Individual provider Active NPI

Edwin Nieves Hernandez, M.D.

  • General Practice Physician
  • Kissimmee, FL
National Provider Identifier
1336687656
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN1233 Issued in FL
Practice address
339 Cypress Pkwy Ste 250
Kissimmee, FL 34759-3315
Phone
(407) 910-1595
Fax
(407) 910-1577
NPI assigned
Feb 7, 2017
Last updated
Aug 24, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 21123 PR
General Practice Physician 208D00000X ACN1233 FL Primary

Addresses

Primary practice location

339 Cypress Pkwy Ste 250
Kissimmee, FL 34759-3315

Mailing address

339 Cypress Pkwy Ste 250
Kissimmee, FL 34759-3315
Phone (407) 910-1595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200319001935 FL Practitioner - General Practice 8426486788 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

339 Cypress Pkwy
Suite 250
Kissimmee, FL 34759-3315
Phone (407) 910-1555

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ACN1233FLMDGeneral Practice Physician
21123PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vida Plus Medical LLC General Practice CurrentSince Dec 8, 2022 Accepting new patients
Medical Home Alliance LLC Past Accepting new patients
Medical Home Alliance LLC PastSince Aug 15, 2021 Accepting new patients

Locations

339 Cypress Pkwy
Ste 250
Kissimmee, FL 34759
Phone (305) 849-4540

339 Cypress Pkwy
Ste 270
Kissimmee, FL 34759

Networks

  • Freedom Health HMO Network

Interoperability endpoints

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

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1486425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1336687656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 CYPRESS PKWY STE 250",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347593315",
            "telephone_number": "407-910-1595",
            "fax_number": "407-910-7577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 CYPRESS PKWY STE 250",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347593315",
            "telephone_number": "407-910-1595",
            "fax_number": "407-910-1577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEVES HERNANDEZ",
        "first_name": "EDWIN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-07",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "21123",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.