Individual provider Active NPI

Maria Elena Dumalaog, M.D.

  • Pediatrics Physician
  • Orlando, FL
National Provider Identifier
1508971698
Registry record updated Jun 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME77853 Issued in FL
Practice address
414 N Mills Ave
Orlando, FL 32803-5722
Phone
(407) 841-7290
Fax
(407) 636-7800
NPI assigned
Aug 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 77853 FL
Pediatrics Physician 208000000X ME77853 FL Primary

Addresses

Primary practice location

414 N Mills Ave
Orlando, FL 32803-5722

Mailing address

414 N Mills Ave
Orlando, FL 32803-5722
Phone (407) 841-7290

Other identifiers 2

IdentifierTypeStateIssuer
005624000MedicaidFL
62150OtherBCBS OF FL

Other names 1

  • Maria Elena Dumalaog-Watson 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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120201000188 FL Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 2264699354

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
77853FLMDPediatrics Physician
ME77853FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health, Inc. Current Accepting new patients
Orlando Physicians Network Inc PastSince Dec 1, 2022 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mdumalaog27074@orlandohealth.medalliesdirect.net

Organizations & group practices 2

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": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593475200000",
    "number": "1508971698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 N MILLS AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328035722",
            "telephone_number": "407-841-7290",
            "fax_number": "407-636-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 N MILLS AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328035722",
            "telephone_number": "407-841-7290",
            "fax_number": "407-636-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUMALAOG",
        "first_name": "MARIA",
        "middle_name": "ELENA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "77853",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME77853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005624000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "62150",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "DUMALAOG-WATSON",
            "middle_name": "ELENA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.