Individual provider Active NPI

Miles Medrano, MD

  • Gastroenterology Physician
  • Atlantis, FL
National Provider Identifier
1366487514
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
ME90022 Issued in FL
Practice address
5401 S Congress Ave
#211
Atlantis, FL 33462-6635
Phone
(561) 964-8221
Fax
(561) 964-7393
NPI assigned
Jun 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X ME90022 FL Primary

Addresses

Primary practice location

5401 S Congress Ave
#211
Atlantis, FL 33462-6635

Mailing address

5401 S Congress Ave Ste 211
Atlantis, FL 33462-6637
Phone (561) 964-8221

Other identifiers 1

IdentifierTypeStateIssuer
27089900MedicaidFL

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
I20040819000992 FL Practitioner - Gastroenterology 8527032218 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of South Florida College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gastroenterology Associates of Florida LLCGroup PAC ID 9335498633, 12 clinicians

Practice addresses (Care Compare)

5401 S Congress Ave
Suite 211
Atlantis, FL 33462-6637
Phone (214) 424-2200

Hospital & facility affiliations

  • Wellington Regional Medical Center Hospital, Wellington, FL, CCN 100275
  • HCA Florida JFK Hospital Hospital, Atlantis, FL, CCN 100080

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy39
Upper gastrointestinal (GI) endoscopy for acid reflux43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME90022FLMDGastroenterology Physician

Organizations & group practices 1

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

Hospital & facility affiliations 2

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": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1366487514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 S CONGRESS AVE STE 211",
            "city": "ATLANTIS",
            "state": "FL",
            "postal_code": "334626637",
            "telephone_number": "561-964-8221",
            "fax_number": "561-964-7393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 S CONGRESS AVE",
            "address_2": "#211",
            "city": "ATLANTIS",
            "state": "FL",
            "postal_code": "334626635",
            "telephone_number": "561-964-8221",
            "fax_number": "561-964-7393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDRANO",
        "first_name": "MILES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME90022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "27089900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlantis, FL

Sources for this page

Verify at the official NPI Registry.