Individual provider Active NPI

Melanie C Letobarone, MD

  • Internal Medicine Physician
  • Lakeland, FL
National Provider Identifier
1669790853
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME120044 Issued in FL
Practice address
4715 S Florida Ave Ste 200
Lakeland, FL 33813-2101
Phone
(863) 209-7004
Fax
(863) 274-3542
NPI assigned
May 12, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME120044 FL
Internal Medicine Physician 207R00000X ME120044 FL Primary

Addresses

Primary practice location

4715 S Florida Ave Ste 200
Lakeland, FL 33813-2101

Mailing address

4715 S Florida Ave Ste 200
Lakeland, FL 33813-2101
Phone (863) 209-7004

Other identifiers 1

IdentifierTypeStateIssuer
012445000MedicaidFL

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
I20140816000240 FL Practitioner - Internal MedicinePractitioner - Pediatric Medicine 3870710726 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Nov 1, 2020 Accepting new patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Nov 1, 2020 Accepting new patients

Locations

206 N Florida Ave
Lakeland, FL 33801
Phone (863) 209-7003

4715 S Florida Ave
Ste 200
Lakeland, FL 33813
Phone (863) 209-7004

4715 S Florida Ave
Lakeland, FL 33813
Phone (863) 209-7003

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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": "1273622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1669790853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4715 S FLORIDA AVE STE 200",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132101",
            "telephone_number": "863-209-7004",
            "fax_number": "863-274-3542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4715 S FLORIDA AVE STE 200",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132101",
            "telephone_number": "863-209-7004",
            "fax_number": "863-274-3542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LETOBARONE",
        "first_name": "MELANIE",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-12",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME120044",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME120044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012445000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.