NPIMap

Individual provider Active NPI

Jessy Casimiro, M.D.

  • Family Medicine Physician
  • Ormond Beach, FL
National Provider Identifier
1639157902
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME0069181 Issued in FL
Practice address
290 Clyde Morris Blvd
Suite A2
Ormond Beach, FL 32174-8130
Phone
(386) 673-9790
Fax
(386) 673-5939
NPI assigned
Jan 5, 2006
Last updated
May 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME0069181 FL Primary

Addresses

Primary practice location

290 Clyde Morris Blvd
Suite A2
Ormond Beach, FL 32174-8130

Mailing address

900 Hope Way
Altamonte Springs, FL 32714-1502
Phone (407) 357-1000

Other identifiers 1

IdentifierTypeStateIssuer
251984400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041116000834 FL Practitioner - Family Practice 5092779355 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Florida College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adventhealth Primary Care Network IncGroup PAC ID 1557722410, 428 clinicians

Practice addresses (Care Compare)

5821 S Williamson Blvd
Suite 204
Port Orange, FL 32128-6102
Phone (386) 231-6300

661 E Altamonte Dr
Suite 115
Altamonte Springs, FL 32701-5102
Phone (407) 831-4040

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0069181FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventhealth Primary Care Network Inc Family Medicine CurrentSince Nov 1, 2023 Accepting new patients

Locations

661 E Altamonte Dr
Ste 115
Altamonte Springs, FL 32701
Phone (407) 831-4040

900 Hope Way
Forest City, FL 32714
Phone (407) 357-1255

Interoperability endpoints

  • Direct secure messaging: jcasimiro71878@adventhealth.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714608000000",
    "number": "1639157902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 HOPE WAY",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327141502",
            "telephone_number": "407-357-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 CLYDE MORRIS BLVD",
            "address_2": "SUITE A2",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321748130",
            "telephone_number": "386-673-9790",
            "fax_number": "386-673-5939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASIMIRO",
        "first_name": "JESSY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0069181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251984400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ormond Beach, FL

Sources for this page

Verify at the official NPI Registry.