Organization Active NPI

Juan M Cancio MD PA

  • Internal Medicine Physician
  • Hialeah, FL
National Provider Identifier
1679803431
Registry record updated Jan 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0056544 Issued in FL
Legal business name
JUAN M CANCIO MD PA
Practice address
777 E 25TH St
Suite 510
Hialeah, FL 33013-3825
Phone
(305) 691-7044
Fax
(305) 691-6010
NPI assigned
Dec 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2010

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

Authorized official

Name
Juan M Cancio, M.D.NPI 1366463796
Title
Medical Doctor
Phone
(305) 691-7044

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X ME0056544 FL Primary

Addresses

Primary practice location

777 E 25TH St
Suite 510
Hialeah, FL 33013-3825

Mailing address

777 E 25TH St
Suite 510
Hialeah, FL 33013-3825
Phone (305) 691-7044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100802000634 FL Part B Supplier - Clinic/Group Practice 2567595267 Receives reassigned benefits from 1 practitioner
Practice locations: Hialeah, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0914200Juan M Cancio MD PA777 E 25TH Street Suite 510, Hialeah, FL 33013Certificate of waiverApr 22, 2028

National Provider Directory

National Provider Directory

Locations

777 E 25th St
Ste 510
Hialeah, FL 33013
Phone (305) 557-2015

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1262131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263340800000",
    "number": "1679803431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 E 25TH ST",
            "address_2": "SUITE 510",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330133825",
            "telephone_number": "305-691-7044",
            "fax_number": "305-691-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 E 25TH ST",
            "address_2": "SUITE 510",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330133825",
            "telephone_number": "305-691-7044",
            "fax_number": "305-691-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUAN M CANCIO MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-30",
        "last_updated": "2010-01-13",
        "status": "A",
        "authorized_official_last_name": "CANCIO",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "305-691-7044",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0056544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.