NPIMap

Individual provider Active NPI

Carlos P Grullon, M.D.

  • Cardiovascular Disease Physician
  • Orlando, FL
National Provider Identifier
1427154756
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME64646 Issued in FL
Practice address
1745 N Mills Ave Ste 100
Orlando, FL 32803-4599
Phone
(407) 841-7151
Fax
(407) 425-2768
NPI assigned
Sep 15, 2006
Last updated
Feb 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X ME64646 FL Primary
Nuclear Cardiology Physician 207UN0901X ME64646 FL

Addresses

Primary practice location

1745 N Mills Ave Ste 100
Orlando, FL 32803-4599

Mailing address

1745 N Mills Ave Ste 100
Orlando, FL 32803-4599
Phone (407) 841-7151

Other identifiers 1

IdentifierTypeStateIssuer
23177OtherFLBLUE SHIELD OF FL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040615000495 FL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Interventional Cardiology 3577547934 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Interventional Cardiology
Education
University Central del Caribe Escuela de Medicina, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1401 S Seminole Blvd
Sanford, FL 32771-6743
Phone (407) 841-7151

2441 W State Rd
426 Suite 2021
Oviedo, FL 32765-4515
Phone (407) 365-7268

4106 W Lake Mary Blvd
Suite 312
Lake Mary, FL 32746-3344
Phone (407) 333-2142

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 841-7151

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting11
Pacemaker insertion or repair1-10
Varicose vein removal39

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME64646FLMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Florida Cardiology Group PA CurrentSince Feb 3, 2025 Accepting new patients
Central Florida Cardiology Group PA Cardiovascular Disease Current Accepting new patients
Southwest Volusia Healthcare Corporation CurrentSince Aug 16, 2021 Accepting new patients
Central Florida Cardiology Interpretations LLC CurrentSince Jun 1, 2003 Accepting new patients
Southwest Volusia Healthcare Corporation CurrentSince Aug 16, 2021 Accepting new patients
Southeast Volusia Medical Services Inc Cardiovascular Disease Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Southwest Volusia Healthcare Corporation Cardiovascular Disease Past Accepting new patients
Jose J Rosales MD PA Past Accepting new patients

Locations

4106 W Lake Mary Blvd
Ste 312
Lake Mary, FL 32746
Phone (407) 333-2142

910 Williston Park Pt
Ste 1000
Lake Mary, FL 32746
Phone (407) 803-8028

1035 Town Center Dr
Orange City, FL 32763
Phone (386) 775-8229

1055 Saxon Blvd
Orange City, FL 32763
Phone (386) 917-5000

1745 N Mills Ave
Orlando, FL 32803
Phone (407) 841-7151

1745 N Mills Ave
Ste 100
Orlando, FL 32803
Phone (407) 841-7151

1745 N Mills Ave
Ste 150
Orlando, FL 32803
Phone (407) 841-7151

2441 W State Road 426
Ste 2021
Oviedo, FL 32765
Phone (407) 365-7268

1401 W Seminole Blvd
Sanford, FL 32771
Phone (317) 805-2316

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: carlos.grullon.1@25476.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/25476/brand/1/csg/1/fhir/r4

Organizations & group practices 10

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 7

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": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1427154756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 N MILLS AVE STE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328034599",
            "telephone_number": "407-841-7151",
            "fax_number": "407-425-2768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 N MILLS AVE STE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328034599",
            "telephone_number": "407-841-7151",
            "fax_number": "407-425-2768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRULLON",
        "first_name": "CARLOS",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME64646",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "FL",
            "license": "ME64646",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF FL",
            "identifier": "23177",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.