Individual provider Active NPI

Beverly A Lense, M.D.

  • Pediatrics Physician
  • Mount Dora, FL
National Provider Identifier
1558352468
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME116906 Issued in FL
Practice address
1502 N Donnelly St Ste 103
Mount Dora, FL 32757-2846
Phone
(352) 383-0624
Fax
(352) 383-0758
NPI assigned
Oct 31, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME116906 FL Primary

Addresses

Primary practice location

1502 N Donnelly St Ste 103
Mount Dora, FL 32757-2846

Mailing address

4137 Hunters Park LN
Orlando, FL 32837-7669
Phone (407) 261-2934

Other practice location 1

4137 Hunters Park Ln
Orlando, FL 32837-7669
Phone (407) 261-2934

Other identifiers 1

IdentifierTypeStateIssuer
252564000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201104001307 KY Practitioner - Pediatric Medicine 4183908171 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mariano D Cibran, MD Corp Dba St Petersburg Pediatrics Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: blense5836496@adventhealth.direct-ci.com

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": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1558352468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4137 HUNTERS PARK LN",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328377669",
            "telephone_number": "407-261-2934",
            "fax_number": "407-636-7811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 N DONNELLY ST STE 103",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327572846",
            "telephone_number": "352-383-0624",
            "fax_number": "352-383-0758"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4137 Hunters Park Ln",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328377669",
            "country_code": "US",
            "telephone_number": "407-261-2934",
            "fax_number": "407-636-7811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LENSE",
        "first_name": "BEVERLY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-31",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME116906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252564000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Dora, FL

Sources for this page

Verify at the official NPI Registry.