Individual provider Active NPI

Rajesh Kacharalal Patel, M.D.

  • Allergy Physician
  • Lake Mary, FL
National Provider Identifier
1619926193
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
ME0062618 Issued in FL
Practice address
1301 S International Parkway
Suite 1011
Lake Mary, FL 32746-1410
Phone
(407) 804-6002
Fax
(407) 804-8777
NPI assigned
May 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X ME0062618 FL
Allergy Physician 207KA0200X ME0062618 FL Primary
Allergy & Immunology (Internal Medicine) Physician 207RA0201X ME0062618 FL
Pediatric Allergy/Immunology Physician 2080P0201X ME0062618 FL

Addresses

Primary practice location

1301 S International Parkway
Suite 1011
Lake Mary, FL 32746-1410

Mailing address

1772 Holland CT
Longwood, FL 32779-3145
Phone (407) 804-6002

Other identifiers 1

IdentifierTypeStateIssuer
378852100MedicaidFL

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
I20050125000721 FL Practitioner - Allergy/Immunology 7618927955 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1301 S International Pkwy
Suite 1011
Lake Mary, FL 32746-1410
Phone (407) 804-6002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0062618FLMDAllergy & Immunology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Asthma Allergy Care Center PL Allergy & Immunology CurrentSince Dec 29, 2004 Accepting new patients
Rene Ab Capulong Mdpa PastSince Dec 29, 2004 Accepting new patients

Locations

1301 S International Pkwy
Ste 1011
Lake Mary, FL 32746
Phone (407) 804-6002

2511 Junior St
Orange City, FL 32763
Phone (386) 736-7600

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": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1619926193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1772 HOLLAND CT",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327793145",
            "telephone_number": "407-804-6002",
            "fax_number": "407-804-8777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 S INTERNATIONAL PARKWAY",
            "address_2": "SUITE 1011",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461410",
            "telephone_number": "407-804-6002",
            "fax_number": "407-804-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "RAJESH",
        "middle_name": "KACHARALAL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "FL",
            "license": "ME0062618",
            "primary": false
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "FL",
            "license": "ME0062618",
            "primary": true
        },
        {
            "code": "207RA0201X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "FL",
            "license": "ME0062618",
            "primary": false
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "FL",
            "license": "ME0062618",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378852100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.