Active NPI
Luke Proctor, DO
- Pediatrics Physician
- Orlando, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- OS20895
- Practice address
- 51 Pennsylvania St
Orlando, FL 32806-2937 - Phone
- (321) 843-3220
- Fax
- (321) 843-3210
- NPI assigned
- May 21, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | OS20895 | FL | Primary |
Addresses
Primary practice location
51 Pennsylvania St
Orlando, FL 32806-2937
Mailing address
51 Pennsylvania St
Orlando, FL 32806-2937
Phone (321) 843-3220
Other practice location 1
92 W Miller St
Orlando, FL 32806-2032
Phone (407) 649-6876
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122302400 | Medicaid | FL |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | https://www.orlandohealth.com/pediatric-residency | ||
| Direct Messaging Address | r-pemmc@orlandohealth.com | Direct |
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS20895 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Hospital Colorado | Current | Accepting new patients | |
| Orlando Health Medical Group Inc | Pediatrics | Current | Accepting new patients |
| Orlando Health Medical Group Inc | Current | Accepting new patients |
Locations
32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820
92 W Miller St
Orlando, FL 32806
Phone (321) 841-4607
51 Pennsylvania St
Orlando, FL 32806
Phone (321) 843-3220
86 Underwood St
Ste 202
Orlando, FL 32806
Interoperability endpoints
- lproctor413976@direct.childrenscolorado.org
Organizations & group practices 3
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719878400000",
"number": "1497320584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 PENNSYLVANIA ST",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328062937",
"telephone_number": "321-843-3220",
"fax_number": "321-843-3210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 PENNSYLVANIA ST",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328062937",
"telephone_number": "321-843-3220",
"fax_number": "321-843-3210"
}
],
"practiceLocations": [
{
"address_1": "92 W Miller St",
"address_purpose": "LOCATION",
"city": "Orlando",
"state": "FL",
"postal_code": "328062032",
"country_code": "US",
"telephone_number": "407-649-6876",
"fax_number": "407-872-0544",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PROCTOR",
"first_name": "LUKE",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-21",
"last_updated": "2024-07-02",
"certification_date": "2024-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "OS20895",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "122302400",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "https://www.orlandohealth.com/pediatric-residency",
"affiliation": "N",
"endpointDescription": "Pediatric Residency Program",
"address_1": "92 W Miller St",
"city": "Orlando",
"state": "FL",
"country_code": "US",
"postal_code": "328062032",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "r-pemmc@orlandohealth.com",
"affiliation": "N",
"endpointDescription": "Email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Email",
"address_1": "51 Pennsylvania St",
"city": "Orlando",
"state": "FL",
"country_code": "US",
"postal_code": "328062937",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Jul 2, 2024; 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.