Individual provider Active NPI

Johanan Vargas, M.D.

  • Pediatrics Physician
  • Brooksville, FL
National Provider Identifier
1649628124
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME142061 Issued in FL
Practice address
11375 Cortez Blvd
Brooksville, FL 34613-5409
Phone
(407) 385-0545
NPI assigned
May 25, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Neonatal-Perinatal Medicine Physician 2080N0001X 142061 FL
Pediatrics Physician 208000000X ME142061 FL Primary

Addresses

Primary practice location

11375 Cortez Blvd
Brooksville, FL 34613-5409

Mailing address

14 Mangrove CT S
Homosassa, FL 34446-4507
Phone (407) 745-1577

Other practice location 1

1650 Grand Concourse
Bronx, NY 10457-7606
Phone (718) 590-1800

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
I20221019002137 FL Practitioner - Pediatric Medicine 5597131391 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
142061FLMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Pediatrics CurrentSince Nov 3, 2022 Accepting new patients
Tampa General Hospital Current Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Nov 3, 2022 Accepting new patients

Locations

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

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

Interoperability endpoints

  • Direct secure messaging: jvargas974397@adventhealth.direct-ci.com
  • Direct secure messaging: jvargas154417@direct.tgh.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 3

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": "1464134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1649628124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MANGROVE CT S",
            "city": "HOMOSASSA",
            "state": "FL",
            "postal_code": "344464507",
            "telephone_number": "407-745-1577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11375 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346135409",
            "telephone_number": "407-385-0545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104577606",
            "country_code": "US",
            "telephone_number": "718-590-1800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VARGAS",
        "first_name": "JOHANAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-25",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "FL",
            "license": "142061",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME142061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooksville, FL

Sources for this page

Verify at the official NPI Registry.