Medical Village Healthcare Group

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

MEDICAL VILLAGE HEALTHCARE GROUP

Practice address

201 Hilda St
Second Floor Suite 21
Kissimmee, FL 34741-2320

Phone

(407) 944-9777

Fax

(407) 888-3310

NPI assigned

Mar 7, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Khalid Manzur, MDNPI 1447223193

Title

President

Phone

(407) 944-9777

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

Medical Village Healthcare Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Medical Village Healthcare Group

  • Pediatrics Physician
  • Orlando, FL
  • NPI 1861630626
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Medical Village Healthcare Group

  • Pediatrics Physician
  • Orlando, FL
  • NPI 1861630626
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Khalid Manzur, M.D

  • Pediatrics Physician
  • Orlando, FL
  • NPI 1447223193

  Internal Medicine

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1487621694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1462 W OAK RIDGE RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328093905",
            "telephone_number": "407-944-9777",
            "fax_number": "407-944-9796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 HILDA ST",
            "address_2": "SECOND FLOOR SUITE 21",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347412320",
            "telephone_number": "407-944-9777",
            "fax_number": "407-888-3310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "816 W Oak St",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "34741",
            "country_code": "US",
            "telephone_number": "407-944-9777",
            "fax_number": "407-944-9796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEDICAL VILLAGE HEALTHCARE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "MANZUR",
        "authorized_official_first_name": "KHALID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-944-9777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PROVIDER UPIN",
            "identifier": "A61366",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PROVIDER PTAN",
            "identifier": "62935Z",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PROVIDER PTAN",
            "identifier": "AC082Z",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PROVIDER UPIN",
            "identifier": "G14896",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medicenter of Orlando
• Karen Matilde Medina Castro
• Mayriluz Del Valle Medina Graterol
• Richard Medina Perez, MD
• Laisy Medina Rodriguez

• Pediatrics Physician in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.