Organization Active NPI

My Endocrinologist PA

  • Endocrinology, Diabetes & Metabolism Physician
  • Winter Garden, FL
National Provider Identifier
1497059737
Registry record updated Aug 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
ME84429 Issued in FL
Legal business name
MY ENDOCRINOLOGIST PA
Practice address
213 S Dillard St
Suite 240
Winter Garden, FL 34787-3522
Phone
(407) 409-8067
Fax
(407) 409-8068
NPI assigned
Dec 30, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2014

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

Authorized official

Name
Maribel Montoya, MDNPI 1477591451
Title
Medical Director
Phone
(352) 409-7103

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
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X ME84429 FL Primary

Addresses

Primary practice location

213 S Dillard St
Suite 240
Winter Garden, FL 34787-3522

Mailing address

213 S Dillard St
Suite 240
Winter Garden, FL 34787-3522
Phone (407) 409-8067

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110314000407 FL Part B Supplier - Clinic/Group Practice 8022290956 Receives reassigned benefits from 8 practitioners
Practice locations: Winter Garden, FL; Davenport, FL

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
10D2019651My Endocrinologist PA213 Dillard St Ste 240, Winter Garden, FL 34787Certificate of waiverFeb 2, 2027

National Provider Directory

National Provider Directory

Locations

213 S Dillard St
Ste 240
Winter Garden, FL 34787
Phone (407) 409-8067

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1293667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407715200000",
    "number": "1497059737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S DILLARD ST",
            "address_2": "SUITE 240",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873522",
            "telephone_number": "407-409-8067",
            "fax_number": "407-409-8068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 S DILLARD ST",
            "address_2": "SUITE 240",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873522",
            "telephone_number": "407-409-8067",
            "fax_number": "407-409-8068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY ENDOCRINOLOGIST PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-30",
        "last_updated": "2014-08-11",
        "status": "A",
        "authorized_official_last_name": "MONTOYA",
        "authorized_official_first_name": "MARIBEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "352-409-7103",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "FL",
            "license": "ME84429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Garden, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.