NPIMap

Individual provider Active NPI

Ilya Fonarov, D.O.

  • Hospitalist Physician
  • Miramar, FL
National Provider Identifier
1679584098
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
OS9021 Issued in FL
Practice address
12955 SW 43Rd CT
Miramar, FL 33027-3182
Phone
(305) 829-1494
NPI assigned
Aug 10, 2006
Last updated
Jun 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS 9021 FL
Hospitalist Physician 208M00000X OS9021 FL Primary

Addresses

Primary practice location

12955 SW 43Rd CT
Miramar, FL 33027-3182

Mailing address

12955 SW 43Rd CT
Miramar, FL 33027-3182
Phone (305) 829-1494

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
I20070525000479 FL Practitioner - Internal Medicine 4183727282 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1611 NW 12 Ave
Miami, FL 33136-1005
Phone (305) 585-1111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.01 of 100Reported as group
Quality
72.99
Promoting interoperability
82
Improvement activities
40
Cost
78.71

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS 9021FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
QMC LLC Hospitalist CurrentSince Aug 12, 2024 Accepting new patients
Public Health Trust of Miami Dade County Florida Internal Medicine CurrentSince Jan 18, 2011 Accepting new patients
Cogent Healthcare of Pensacola LLC Internal Medicine Current Accepting new patients
Cogent Healthcare of Pensacola LLC Internal Medicine CurrentSince Feb 25, 2023 Accepting new patients
First Docs PC Internal Medicine CurrentSince Jan 14, 2025 Accepting new patients
Cogent Healthcare of Pensacola LLC Internal Medicine CurrentSince Feb 25, 2023 Accepting new patients
Public Health Trust of Miami Dade County Florida CurrentSince Jan 18, 2011 Accepting new patients
Public Health Trust of Dade County Florida Past Accepting new patients

Locations

17240 Cortez Blvd
Brooksville, FL 34601
Phone (352) 544-6060

14550 Old St Augustine Rd
Jacksonville, FL 32258
Phone (904) 202-5010

3625 University Blvd S
Jacksonville, FL 32216
Phone (904) 333-9404

1500 Lee Blvd
Lehigh Acres, FL 33936
Phone (239) 368-4410

1611 NW 12th Ave
Miami, FL 33136
Phone (305) 585-6226

1611 NW 12th Ave
#600B
Miami, FL 33136
Phone (305) 355-1245

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

2801 NW 79th Ave
Miami, FL 33122
Phone (786) 466-1000

333 SE 2nd Ave
Ste 2000
Miami, FL 33131
Phone (201) 581-3411

4960 SW 72nd Ave
Ste 303
Miami, FL 33155
Phone (305) 591-1606

830 Lakeside Cir
Pompano Beach, FL 33060
Phone (954) 247-5801

7031 SW 62nd Ave
South Miami, FL 33143
Phone (305) 284-7585

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 8

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1679584098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12955 SW 43RD CT",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330273182",
            "telephone_number": "305-829-1494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12955 SW 43RD CT",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330273182",
            "telephone_number": "305-829-1494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONAROV",
        "first_name": "ILYA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS 9021",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "FL",
            "license": "OS9021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miramar, FL

Sources for this page

Verify at the official NPI Registry.