Individual provider Active NPI

Michelle Sarah Modaff, D.D.S.

  • General Practice Dentistry
  • Avon Park, FL
National Provider Identifier
1497768295
Registry record updated Apr 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
HAD 33 Issued in FL
Practice address
950 County Road 17a W
Avon Park, FL 33825-2164
Phone
(863) 452-3000
NPI assigned
Aug 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X HAD 33 FL Primary

Addresses

Primary practice location

950 County Road 17a W
Avon Park, FL 33825-2164

Mailing address

47 5TH St NW
Winter Haven, FL 33881-4672
Phone (863) 268-7850

Other names 1

  • Dr. Michelle Sarah Trifu Former name

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151103001646 FL Order and Referring Only - DentistPractitioner - Dentist 0547570533

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
HAD 33FLMDGeneral Practice Dentistry

Practice roles (8 of 9)

OrganizationSpecialtyStatusNew patients
Central Florida Health Care, Inc. General Practice Past Accepting new patients
Central Florida Health Care Inc General Practice Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc Past Accepting new patients
Central Florida Health Care, Inc. General Practice Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc General Practice Past Accepting new patients

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: michelle.modaff.1@12125.direct.athenahealth.com

Organizations & group practices 8

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": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555027200000",
    "number": "1497768295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 5TH ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814672",
            "telephone_number": "863-268-7850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 COUNTY ROAD 17A W",
            "city": "AVON PARK",
            "state": "FL",
            "postal_code": "338252164",
            "telephone_number": "863-452-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODAFF",
        "first_name": "MICHELLE",
        "middle_name": "SARAH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2019-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "HAD 33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "TRIFU",
            "middle_name": "SARAH",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Avon Park, FL

Sources for this page

Verify at the official NPI Registry.