Individual provider Active NPI

Luis E Ruiz Velez

  • Family Nurse Practitioner
  • Lake Wales, FL
National Provider Identifier
1417810227
Registry record updated Dec 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11044097 Issued in FL
Practice address
264 Taylor Groves St
Lake Wales, FL 33898-5154
Phone
(407) 744-2920
NPI assigned
Dec 8, 2025
Last updated
Dec 8, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11044097 FL Primary

Addresses

Primary practice location

264 Taylor Groves St
Lake Wales, FL 33898-5154

Mailing address

264 Taylor Groves St
Lake Wales, FL 33898-5154

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260115003354 FL Practitioner - Nurse Practitioner 2365929759 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MP Primary Care ServicesGroup PAC ID 7618357880, 12 clinicians

Practice addresses (Care Compare)

2778 US Hwy 27 S
Avon Park, FL 33825-9755
Phone (863) 417-9990

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11044097FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Depression and Mental Health Services, LLC CurrentSince Jan 9, 2026 Accepting new patients
MP Primary Care Services Family CurrentSince Jan 9, 2026 Accepting new patients

Locations

2778 US Highway 27 S
Avon Park, FL 33825
Phone (863) 336-5888

200 N John Young Pkwy
Ste 101
Kissimmee, FL 34741
Phone (407) 518-9339

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1765152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765152000000",
    "number": "1417810227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 TAYLOR GROVES ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338985154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 TAYLOR GROVES ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338985154",
            "telephone_number": "407-744-2920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUIZ VELEZ",
        "first_name": "LUIS",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-08",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11044097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wales, FL

Sources for this page

Verify at the official NPI Registry.