Organization Active NPI

Leticia Adan MD PA

  • Nephrology Physician
  • Miami Beach, FL
National Provider Identifier
1346287729
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
LETICIA ADAN MD PA
Practice address
4302 Alton Rd Ste 420
Miami Beach, FL 33140-2849
Phone
(305) 531-1664
Fax
(305) 531-9965
NPI assigned
Jun 2, 2006
Last updated
Sep 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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

Authorized official

Name
Charisse Majella Distura Jingco
Title
Office Manager
Phone
(305) 531-1664

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

4302 Alton Rd Ste 420
Miami Beach, FL 33140-2849

Mailing address

4302 Alton Rd Ste 420
Miami Beach, FL 33140-2849
Phone (305) 216-5048

Other identifiers 2

IdentifierTypeStateIssuer
38275OtherFLBLUE CROSS BLUE SHIELD
DB3262OtherFLRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060908000117 FL Part B Supplier - Clinic/Group Practice 5991709826 Receives reassigned benefits from 2 practitioners
Practice locations: Miami Beach, FL

National Provider Directory

National Provider Directory

Locations

4302 Alton Rd
Ste 420
Miami Beach, FL 33140
Phone (305) 531-1664

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662508800000",
    "number": "1346287729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4302 ALTON RD STE 420",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331402849",
            "telephone_number": "305-216-5048",
            "fax_number": "305-531-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4302 ALTON RD STE 420",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331402849",
            "telephone_number": "305-531-1664",
            "fax_number": "305-531-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LETICIA ADAN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A",
        "authorized_official_last_name": "JINGCO",
        "authorized_official_first_name": "CHARISSE MAJELLA",
        "authorized_official_middle_name": "DISTURA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "305-531-1664"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "38275",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DB3262",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; 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.