NPIMap

Individual provider Active NPI

Lysmar Carrion Dinguis, M.D.

  • General Practice Physician
  • Lakeland, FL
National Provider Identifier
1649572249
Registry record updated May 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN476 Issued in FL
Practice address
4729 US Highway 98 S Ste 201
Lakeland, FL 33812-4336
Phone
(863) 646-9663
Fax
(863) 646-9664
NPI assigned
Dec 2, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X ACN476 FL Primary
General Practice Physician 208D00000X 17887 PR

Addresses

Primary practice location

4729 US Highway 98 S Ste 201
Lakeland, FL 33812-4336

Mailing address

6675 Westwood Blvd Ste 475
Orlando, FL 32821-6027
Phone (407) 845-0384

Other identifiers 3

IdentifierTypeStateIssuer
008701300MedicaidFL
17887OtherPRTEM
HE785ZOtherFLMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120322000507 PR Practitioner - General Practice 0345400701 Reassigns benefits to 1 organization
I20130529000571 FL Practitioner - General Practice 0345400701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Home Alliance, LLCGroup PAC ID 6406096536, 60 clinicians

Practice addresses (Care Compare)

4729 US Hwy 98 S
Suite 201
Lakeland, FL 33812-4336
Phone (863) 646-9663

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Lakeland, FL, CCN 107166
  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ACN476FLMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Home Alliance LLC CurrentSince Dec 10, 2023 Accepting new patients
Medical Home Alliance LLC CurrentSince Aug 24, 2020 Accepting new patients
Southern Health Care Group, Inc. General Practice CurrentSince Jan 7, 2012 Accepting new patients
Medical Home Alliance LLC Past Accepting new patients

Locations

4729 US Highway 98 S
Ste 201
Lakeland, FL 33812
Phone (863) 646-9663

4725 US Highway 98 S
Ste 101
Lakeland, FL 33812
Phone (863) 646-9663

6675 Westwood Blvd
Ste 475
Orlando, FL 32821
Phone (407) 845-0384

199 Avenue K SE
Winter Haven, FL 33880
Phone (563) 588-1424

Networks

  • Freedom Health HMO Network

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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": "1291248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1649572249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6675 WESTWOOD BLVD STE 475",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328216027",
            "telephone_number": "407-845-0384",
            "fax_number": "888-972-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4729 US HIGHWAY 98 S STE 201",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338124336",
            "telephone_number": "863-646-9663",
            "fax_number": "863-646-9664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRION DINGUIS",
        "first_name": "LYSMAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-02",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN476",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "17887",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008701300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEM",
            "identifier": "17887",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "HE785Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.