NPIMap

Organization Active NPI

Myrtho Mompoint-Branch MD PA

  • Psychiatry Physician
  • Orlando, FL
National Provider Identifier
1689686412
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
ME73432 Issued in FL
Legal business name
MYRTHO MOMPOINT-BRANCH MD PA
Practice address
2500 Discovery Dr
Orlando, FL 32826-3709
Phone
(407) 275-2203
Fax
(407) 282-7012
NPI assigned
Aug 12, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Myrtho Mompoint-Branch, MD
Title
President
Phone
(407) 275-2203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X ME73432 FL Primary

Addresses

Primary practice location

2500 Discovery Dr
Orlando, FL 32826-3709

Mailing address

2500 Discovery Dr
Orlando, FL 32826-3709
Phone (407) 275-2203

Other identifiers 1

IdentifierTypeStateIssuer
46298OtherFLBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220930000823 FL Part B Supplier - Clinic/Group Practice 6406232354 Receives reassigned benefits from 5 practitioners
Practice locations: Winter Springs, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689686412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 DISCOVERY DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328263709",
            "telephone_number": "407-275-2203",
            "fax_number": "407-282-7012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 DISCOVERY DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328263709",
            "telephone_number": "407-275-2203",
            "fax_number": "407-282-7012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRTHO MOMPOINT-BRANCH MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOMPOINT-BRANCH",
        "authorized_official_first_name": "MYRTHO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-275-2203",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME73432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "46298",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.