Individual provider Active NPI

Robert M Sutphin, MD

  • Pediatric Hematology & Oncology Physician
  • Orlando, FL
National Provider Identifier
1497957591
Registry record updated Nov 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
ME98617 Issued in FL
Practice address
92 W Miller St
Orlando, FL 32806-2032
Phone
(321) 841-8588
Fax
(321) 841-8560
NPI assigned
Jun 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X ME98617 FL Primary

Addresses

Primary practice location

92 W Miller St
Orlando, FL 32806-2032

Mailing address

92 W Miller St
Orlando, FL 32806-2032
Phone (321) 841-8588

Other identifiers 2

IdentifierTypeStateIssuer
ME98617OtherFLMEDICAL LICENSE
279319900MedicaidFL

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
I20071003000258 FL Practitioner - Pediatric MedicinePractitioner - Hematology/Oncology 8527153717 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME98617FLMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc Pediatric Hematology-Oncology CurrentSince Jan 1, 2014 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Jan 1, 2014 Accepting new patients
Orlando Cancer Center Inc Past Accepting new patients

Locations

92 W Miller St
Orlando, FL 32806
Phone (321) 841-4607

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

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

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": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478736000000",
    "number": "1497957591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 W MILLER ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062032",
            "telephone_number": "321-841-8588",
            "fax_number": "321-841-8560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 W MILLER ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062032",
            "telephone_number": "321-841-8588",
            "fax_number": "321-841-8560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTPHIN",
        "first_name": "ROBERT",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-01",
        "last_updated": "2016-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "FL",
            "license": "ME98617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME98617",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "279319900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.