NPIMap

Organization Active NPI

Orlando Immunology Center PA

  • Infectious Disease Physician
  • Orlando, FL
National Provider Identifier
1467003772
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
ORLANDO IMMUNOLOGY CENTER PA
Practice address
1707 N Mills Ave
Orlando, FL 32803-1851
Phone
(407) 647-3960
Fax
(407) 413-5775
NPI assigned
Sep 27, 2019
Last updated
May 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Edwin Dejesus, MDNPI 1295734101
Title
Owner
Phone
(407) 647-3960

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X NU Primary

Addresses

Primary practice location

1707 N Mills Ave
Orlando, FL 32803-1851

Mailing address

1707 N Mills Ave
Orlando, FL 32803-1851
Phone (407) 647-3960

Other identifiers 1

IdentifierTypeStateIssuer
104671400MedicaidFL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0953875Orlando Immunology Center PA1707 N Mills Ave, Orlando, FL 32803Certificate of waiverNov 12, 2026

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: angelaeakels@oicpa.allscriptsdirect.net
  • Direct secure messaging: charlotte-paigerolle@oicpa.allscriptsdirect.net
  • Direct secure messaging: dancruz@oicpa.allscriptsdirect.net
  • Direct secure messaging: edwindejesus@oicpa.allscriptsdirect.net
  • Direct secure messaging: federicohinestrosa@oicpa.allscriptsdirect.net
  • Direct secure messaging: jeffreygarrett@oicpa.allscriptsdirect.net
  • Direct secure messaging: phillipmaxwell@oicpa.allscriptsdirect.net
  • Direct secure messaging: stephanieskipper@oicpa.allscriptsdirect.net
  • Direct secure messaging: terrywilder@oicpa.allscriptsdirect.net

Practitioners & affiliated clinicians

Practitioners 77

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1569542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1467003772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 N MILLS AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031851",
            "telephone_number": "407-647-3960",
            "fax_number": "407-413-5775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 N MILLS AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031851",
            "telephone_number": "407-647-3960",
            "fax_number": "407-413-5775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORLANDO IMMUNOLOGY CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-27",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "DEJESUS",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-647-3960",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104671400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.