Individual provider Active NPI

Channel R Ancheta, ARNP

  • Family Nurse Practitioner
  • Miami, FL
National Provider Identifier
1578073532
Registry record updated Oct 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9340265 Issued in FL
Practice address
8501 SW 124TH Ave Ste 102a
Miami, FL 33183-4631
Phone
(305) 228-4422
NPI assigned
Oct 4, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 4, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X ARNP9340265 FL Primary

Addresses

Primary practice location

8501 SW 124TH Ave Ste 102a
Miami, FL 33183-4631

Mailing address

5390 W 9TH CT
Hialeah, FL 33012-2435
Phone (786) 521-1712

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180709000610 FL Practitioner - Nurse Practitioner 6800142712 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ARNP9340265FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Roberto Polanco MD PA Single Specialty CurrentSince Oct 28, 2018 Accepting new patients
Miami Jewish Health Systems, Inc. Single Specialty CurrentSince Jan 13, 2018 Accepting new patients

Locations

8501 SW 124th Ave
Ste 102A
Miami, FL 33183
Phone (305) 228-4422

5200 NE 2nd Ave
Miami, FL 33137
Phone (305) 762-1387

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": "1507075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507075200000",
    "number": "1578073532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5390 W 9TH CT",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330122435",
            "telephone_number": "786-521-1712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8501 SW 124TH AVE STE 102A",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331834631",
            "telephone_number": "305-228-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANCHETA",
        "first_name": "CHANNEL",
        "middle_name": "R",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-04",
        "last_updated": "2017-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9340265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.