Individual provider Active NPI

Luke Proctor, DO

  • Pediatrics Physician
  • Orlando, FL
National Provider Identifier
1497320584
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
OS20895 Issued in FL
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

Updated by the provider on Jul 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
122302400MedicaidFL

Electronic endpoints 2

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240520001659 FL Practitioner - Pediatric Medicine 6901248194 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS20895FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Colorado Current Accepting new patients
Orlando Health Medical Group Inc Pediatrics CurrentSince Jul 1, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Jul 1, 2024 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.