Orlando Jose Icaza, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

ME66190 Issued in FL

Practice address

732 N 3Rd St
Leesburg, FL 34748-4442

Phone

(352) 265-8356

Fax

(352) 787-0854

NPI assigned

Jul 15, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Florida Clinical Practice Association Inc

  • Surgery Physician
  • Gainesville, FL
  • NPI 1063463768
  Medicare reassignment NPD
• Florida Clinical Practice Association Inc

  • Durable Medical Equipment & Medical Supplies
  • Ocala, FL
  • NPI 1609529478
  NPD
• Pathology Medical Laboratories

  • Clinical Medical Laboratory
  • Leesburg, FL
  • NPI 1003896853
  NPD (past)
• Premiere Medical Laboratories P a

  • Clinical Medical Laboratory
  • Leesburg, FL
  • NPI 1518145259
  NPD (past)
• WCP Pathology, PC

  • Clinical Medical Laboratory
  • Maryland Heights, MO
  • NPI 1215008396

  Anatomic Pathology & Clinical Pathology

  NPD (past)

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1447259106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100275",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100275",
            "telephone_number": "352-273-7839",
            "fax_number": "352-273-8172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 N 3RD ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347484442",
            "telephone_number": "352-265-8356",
            "fax_number": "352-787-0854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICAZA",
        "first_name": "ORLANDO",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-15",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME66190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267636200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "71176",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00208162",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Ryan Hyatt, PTA
• Suzanne Marie Hynds, A.R.N.P.
• Cheyenne Hynes
• I Care Companion Services LLC
• Conswello Ibe
• Don John Ilkka, D.D.S.
• Muhammed Isiaku Imam
• Imani Support Services LLC
• Impact Behavior Supports, Inc
• Imperfectly Balanced Counseling and Consulting, LLC

• Anatomic Pathology & Clinical Pathology Physician in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.