Individual provider Active NPI

Ibelith Miranda-Moreno, MD

  • General Practice Physician
  • Kissimmee, FL
National Provider Identifier
1477575207
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN1390 Issued in FL
Practice address
1051 Kevstin Dr
Kissimmee, FL 34744-5811
Phone
(321) 257-8007
Fax
(407) 490-1309
NPI assigned
Jul 24, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X ACN1390 FL Primary

Addresses

Primary practice location

1051 Kevstin Dr
Kissimmee, FL 34744-5811

Mailing address

PO Box 4189
Deerfield Beach, FL 33442-4189
Phone (954) 363-9582

Other practice location 1

2548 Simpson Rd
Kissimmee, FL 34744-4637
Phone (407) 632-4201

Other identifiers 1

IdentifierTypeStateIssuer
112495900MedicaidFL

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
I20211028001130 FL Practitioner - General Practice 2668494964 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valora Medical Center of Florida LLCGroup PAC ID 7113368911, 9 clinicians

Practice addresses (Care Compare)

7151 University Blvd
Unit 100
Winter Park, FL 32792-6724
Phone (321) 275-7500

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ACN1390FLMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valora Medical Center of Florida LLC Clinic/Center CurrentSince Jul 16, 2025 Accepting new patients
Patient Medical Center of Florida Inc General Practice CurrentSince Jan 1, 2024 Accepting new patients
Orlando Family Physicians, LLC General Practice PastSince Jan 5, 2025 Accepting new patients
Family Health Group S.S.C.S.P General Practice Past Accepting new patients
Lina L Feaster PA Clinic/Center PastSince Jan 2, 2004 Accepting new patients
Programa Medico del Norte, Inc. Clinic/Center Past Accepting new patients

Locations

819 N Central Ave
Ste A
Kissimmee, FL 34741
Phone (407) 288-8242

819 N Central Ave
Kissimmee, FL 34741
Phone (407) 288-8242

7151 University Blvd
Unit 100
Winter Park, FL 32792
Phone (321) 275-7500

5601 Executive Dr
Ste 200
Irving, TX 75038
Phone (352) 565-7290

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 6

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": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1477575207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4189",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334424189",
            "telephone_number": "954-363-9582",
            "fax_number": "954-363-9663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 KEVSTIN DR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347445811",
            "telephone_number": "321-257-8007",
            "fax_number": "407-490-1309"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2548 Simpson Rd",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347444637",
            "country_code": "US",
            "telephone_number": "407-632-4201",
            "fax_number": "407-632-4206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRANDA-MORENO",
        "first_name": "IBELITH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112495900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.