Individual provider Active NPI

Samuel Dejesus, MD

  • Colon & Rectal Surgery Physician
  • Orlando, FL
National Provider Identifier
1497757645
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
ME78134 Issued in FL
Practice address
32 W Gore St Ste 204
Orlando, FL 32806-1134
Phone
(407) 649-6884
Fax
(407) 245-7059
NPI assigned
Jun 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X ME78134 FL Primary

Addresses

Primary practice location

32 W Gore St Ste 204
Orlando, FL 32806-1134

Mailing address

32 W Gore St Ste 204
Orlando, FL 32806-1134
Phone (407) 649-6884

Other identifiers 1

IdentifierTypeStateIssuer
259597400MedicaidFL

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
I20040913000433 FL Practitioner - Colorectal Surgery (Proctology) 8426025271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

10000 W Colonial Dr
Ocoee, FL 34761-3400
Phone (407) 578-0033

22 W Underwood St
Orlando, FL 32806-1110
Phone (407) 648-3800

32 W Gore St
Orlando, FL 32806-1134

380 Rinehart Rd
Lake Mary, FL 32746-2551
Phone (407) 767-1200

52 W Underwood St
Orlando, FL 32806-1110
Phone (407) 841-5111

76 W Underwood St
Orlando, FL 32806-1110

86 W Underwood St
Orlando, FL 32806-1110
Phone (407) 896-1100

9400 Turkey Lake Rd
Orlando, FL 32819-8001
Phone (407) 354-1202

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy54
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Dec 16, 2010 Accepting new patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Dec 16, 2010 Accepting new patients
Central Florida Anesthesia Services LLC PastSince Apr 1, 2019 Accepting new patients
Orlando Health Inc Past Accepting new patients

Locations

521 W State Road 434
Ste 308
Longwood, FL 32750
Phone (321) 841-3200

32 W Gore St
Ste 204
Orlando, FL 32806
Phone (321) 841-0000

1400 S Orange Ave
Orlando, FL 32806
Phone (321) 841-1893

9964 University Blvd
Orlando, FL 32817
Phone (407) 261-2900

110 Underwood St
Ste H
Orlando, FL 32806

77 Underwood St
Ste 200
Orlando, FL 32806
Phone (407) 649-6884

110 Underwood St
Orlando, FL 32806
Phone (407) 422-3790

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

110 Underwood St
Ste A
Orlando, FL 32806
Phone (407) 422-3790

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: sdejesus25266@orlandohealth.medalliesdirect.net

Organizations & group practices 5

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1497757645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 W GORE ST STE 204",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061134",
            "telephone_number": "407-649-6884",
            "fax_number": "407-245-7059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 W GORE ST STE 204",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061134",
            "telephone_number": "407-649-6884",
            "fax_number": "407-245-7059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJESUS",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "FL",
            "license": "ME78134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "259597400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.