Individual provider Active NPI

Jose Antonio Urdaneta-Jaimes, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Kissimmee, FL
National Provider Identifier
1689645921
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
ME84353 Issued in FL
Practice address
1121 N Central Ave
Suite B
Kissimmee, FL 34741-4405
Phone
(407) 933-1221
Fax
(407) 933-0747
NPI assigned
Jan 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X ME84353 FL
Critical Care Medicine (Internal Medicine) Physician 207RC0200X ME84353 FL Primary

Addresses

Primary practice location

1121 N Central Ave
Suite B
Kissimmee, FL 34741-4405

Mailing address

1121 N Central Ave
Suite B
Kissimmee, FL 34741-4405
Phone (407) 933-1221

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
I20060821000021 FL Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 9234132853 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME84353FLMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intensive Care Consortium Inc Critical Care Medicine CurrentSince Sep 3, 2013 Accepting new patients
Pulmonary Disease Specialists, PA Pulmonary Disease CurrentSince Oct 1, 2007 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Aug 29, 2016 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Aug 29, 2016 Accepting new patients

Locations

110 Park Place Blvd
Davenport, FL 33837
Phone (863) 419-0104

1121 N Central Ave
Kissimmee, FL 34741
Phone (407) 933-1221

1121 N Central Ave
Ste B
Kissimmee, FL 34741
Phone (407) 933-1221

290 Park Place Blvd
Kissimmee, FL 34741
Phone (407) 933-1221

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

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

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": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1689645921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 N CENTRAL AVE",
            "address_2": "SUITE B",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414405",
            "telephone_number": "407-933-1221",
            "fax_number": "407-933-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 N CENTRAL AVE",
            "address_2": "SUITE B",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414405",
            "telephone_number": "407-933-1221",
            "fax_number": "407-933-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "URDANETA-JAIMES",
        "first_name": "JOSE",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "FL",
            "license": "ME84353",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "FL",
            "license": "ME84353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.