Individual provider Active NPI

Melissa Bahareh Bagloo, MD

  • Surgery Physician
  • Winter Park, FL
National Provider Identifier
1407016108
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
ME146371 Issued in FL
Practice address
1925 Mizell Ave Ste 201
Winter Park, FL 32792-4155
Phone
(407) 303-7399
NPI assigned
Jun 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 246679-1 NY
Surgery Physician 208600000X 25MA08805600 NJ
Surgery Physician 208600000X ME146371 FL Primary

Addresses

Primary practice location

1925 Mizell Ave Ste 201
Winter Park, FL 32792-4155

Mailing address

1925 Mizell Ave Ste 201
Winter Park, FL 32792-4155
Phone (407) 303-7399

Other identifiers 1

IdentifierTypeStateIssuer
03112663MedicaidNY

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
I20211026000241 FL Practitioner - General Surgery 5890849632 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Florida College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

1925 Mizell Ave
Suite 201
Winter Park, FL 32792-4155
Phone (407) 646-7845

Hospital & facility affiliations

  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
246679-1NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Surgery CurrentSince Dec 6, 2021 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Dec 6, 2021 Accepting new patients

Locations

410 Celebration Pl
Ste 401A
Kissimmee, FL 34747
Phone (407) 303-3820

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

1925 Mizell Ave
Ste 201
Winter Park, FL 32792
Phone (407) 303-7399

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: mbagloo227927@adventhealth.direct-ci.com

Organizations & group practices 2

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": "1213574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1407016108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 MIZELL AVE STE 201",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327924155",
            "telephone_number": "407-303-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 MIZELL AVE STE 201",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327924155",
            "telephone_number": "407-303-7399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGLOO",
        "first_name": "MELISSA",
        "middle_name": "BAHAREH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-16",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "246679-1",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA08805600",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME146371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03112663",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Park, FL

Sources for this page

Verify at the official NPI Registry.