Active NPI
Russell H Wheatley, D.O.
- Family Medicine Physician
- Winter Park, FL
National Provider Identifier
1366490948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS5336
- Practice address
- 3099 Aloma Ave
Winter Park, FL 32792-3702 - Phone
- (407) 677-1140
- Fax
- (407) 677-5841
- NPI assigned
- May 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS5336 | FL | Primary |
Addresses
Primary practice location
3099 Aloma Ave
Winter Park, FL 32792-3702
Mailing address
3099 Aloma Ave
Winter Park, FL 32792-3702
Phone (407) 677-1140
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27136200 | Medicaid | FL | |
| 80173 | Other | FL | BC/BS OF FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS5336 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Emergency Physicians Kang and Associates MD LLC | Past | Accepting new patients |
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
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.
-
- Emergency Medical Services (Emergency Medicine) Physician
- Orlando, FL
- NPI 1811983752
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415232000000",
"number": "1366490948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3099 ALOMA AVE",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327923702",
"telephone_number": "407-677-1140",
"fax_number": "407-677-5841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3099 ALOMA AVE",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327923702",
"telephone_number": "407-677-1140",
"fax_number": "407-677-5841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHEATLEY",
"first_name": "RUSSELL",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-05",
"last_updated": "2014-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "OS5336",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "27136200",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF FL",
"identifier": "80173",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winter Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.