Individual provider Active NPI

Erick Enerio Santana Alcantara, MD

  • Pediatrics Physician
  • Kissimmee, FL
National Provider Identifier
1629530936
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME154567 Issued in FL
Practice address
3070 Dyer Blvd
Kissimmee, FL 34741-7839
Phone
(407) 932-7930
Fax
(321) 203-4655
NPI assigned
Apr 4, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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 ME154567 FL Primary

Addresses

Primary practice location

3070 Dyer Blvd
Kissimmee, FL 34741-7839

Mailing address

3070 Dyer Blvd
Kissimmee, FL 34741-7839
Phone (407) 932-7930

Other practice location 1

7051 Dr Phillips Blvd Ste 7
Orlando, FL 32819-5140
Phone (407) 249-1234

Other identifiers 1

IdentifierTypeStateIssuer
115310100MedicaidFL

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
I20240902000474 FL Practitioner - Pediatric Medicine 3375985104 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Physicians Network Inc CurrentSince Aug 1, 2024 Accepting new patients

Locations

3070 Dyer Blvd
Kissimmee, FL 34741
Phone (407) 932-7930

3236 N Poinciana Blvd
Kissimmee, FL 34746
Phone (321) 542-3786

21 Columbia St
Orlando, FL 32806
Phone (321) 841-5560

Organizations & group practices 1

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": "1554336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1629530936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3070 DYER BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347417839",
            "telephone_number": "407-932-7930",
            "fax_number": "321-203-4655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3070 DYER BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347417839",
            "telephone_number": "407-932-7930",
            "fax_number": "321-203-4655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7051 Dr Phillips Blvd Ste 7",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328195140",
            "country_code": "US",
            "telephone_number": "407-249-1234",
            "fax_number": "407-249-1755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANTANA ALCANTARA",
        "first_name": "ERICK",
        "middle_name": "ENERIO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-04",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME154567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115310100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.