Active NPI
Karymar Del Valle Serrano, M.D.
- General Practice Physician
- Lake City, FL
National Provider Identifier
1477791465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 17446
- Practice address
- 619 S Marion Ave
Lake City, FL 32025-5808 - Phone
- (386) 755-3016
- Fax
- (386) 719-3622
- NPI assigned
- Jan 28, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 17446 | PR | Primary |
Addresses
Primary practice location
619 S Marion Ave
Lake City, FL 32025-5808
Mailing address
619 S Marion Ave
Lake City, FL 32025-5808
Phone (386) 755-3016
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012467000 | Medicaid | FL | |
| ACN553 | Other | FL | STATE LICENSE |
| CU181A | Other | FL | MEDICARE - PR |
| 17446 | Other | PR | STATE LICENSE |
| HV698Z | Other | FL | MEDICARE - FL |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230420000013 | FL | Order and Referring Only - General Practice | 1153465307 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435017600000",
"number": "1477791465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "619 S MARION AVE",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320255808",
"telephone_number": "386-755-3016",
"fax_number": "386-719-3622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 S MARION AVE",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320255808",
"telephone_number": "386-755-3016",
"fax_number": "386-719-3622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEL VALLE SERRANO",
"first_name": "KARYMAR",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-28",
"last_updated": "2015-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "PR",
"license": "17446",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "012467000",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "ACN553",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE - PR",
"identifier": "CU181A",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "17446",
"state": "PR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE - FL",
"identifier": "HV698Z",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; 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.