Individual provider Active NPI

Luke Adam Peng

  • Adult Health Nurse Practitioner
  • Longwood, FL
National Provider Identifier
1689499246
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN11036482 Issued in FL
Practice address
555 W State Road 434
Longwood, FL 32750-5119
Phone
(407) 767-1200
NPI assigned
Nov 19, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 11036482 FL
Adult Health Nurse Practitioner 363LA2200X APRN11036482 FL Primary

Addresses

Primary practice location

555 W State Road 434
Longwood, FL 32750-5119

Mailing address

555 W State Road 434
Longwood, FL 32750-5119
Phone (321) 842-8505

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250108002246 FL Practitioner - Nurse Practitioner 8325576093 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

555 W State Rd
Suite 434
Longwood, FL 32750-5119
Phone (321) 842-2994

Hospital & facility affiliations

  • Orlando Health Hospital, Orlando, FL, CCN 100006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11036482FLMDAcute Care Nurse Practitioner
APRN11036482FLMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Dec 16, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Dec 16, 2024 Accepting new patients

Locations

555 W State Road 434
Longwood, FL 32750
Phone (407) 767-1200

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare 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.

Hospital & facility affiliations 1

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": "1731974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1689499246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W STATE ROAD 434",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505119",
            "telephone_number": "321-842-8505",
            "fax_number": "321-843-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W STATE ROAD 434",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505119",
            "telephone_number": "407-767-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENG",
        "first_name": "LUKE",
        "middle_name": "ADAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-19",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "11036482",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11036482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longwood, FL

Sources for this page

Verify at the official NPI Registry.