Individual provider Active NPI

Samuel Aaron Stephenson, MD

  • Pediatrics Physician
  • Orlando, FL
National Provider Identifier
1407085798
Registry record updated Mar 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME113422 Issued in FL
Practice address
5900 S John Young Pkwy
Orlando, FL 32839-3716
Phone
(407) 398-6470
Fax
(407) 894-6872
NPI assigned
Jul 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME113422 FL Primary

Addresses

Primary practice location

5900 S John Young Pkwy
Orlando, FL 32839-3716

Mailing address

5900 South John Young Pkwy
Orlando, FL 32839
Phone (407) 398-6470

Other identifiers 1

IdentifierTypeStateIssuer
006440100MedicaidFL

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
I20160210001703 FL Practitioner - Pediatric Medicine 5698910438 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME113422FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Florida Emergency Management LLC CurrentSince Jan 1, 2024 Accepting new patients
Emergency Medicine Services of FL, LLC CurrentSince Apr 1, 2023 Accepting new patients

Locations

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

14000 Fivay Rd
Hudson, FL 34667
Phone (727) 819-2929

700 W Oak St
Kissimmee, FL 34741
Phone (407) 518-3553

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

350 7th St N
Naples, FL 34102
Phone (239) 436-5000

11190 Health Park Blvd
Naples, FL 34110
Phone (239) 300-9721

105 Tamiami Trl
Fl Tamiami
Port Charlotte, FL 33953

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490918400000",
    "number": "1407085798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 SOUTH JOHN YOUNG PKWY",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32839",
            "telephone_number": "407-398-6470",
            "fax_number": "407-894-6872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 S JOHN YOUNG PKWY",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328393716",
            "telephone_number": "407-398-6470",
            "fax_number": "407-894-6872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENSON",
        "first_name": "SAMUEL",
        "middle_name": "AARON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-08",
        "last_updated": "2017-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME113422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006440100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.