Jill Edwards Ata, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

DN18675 Issued in FL

Practice address

3192 S John Young Pkwy
Suite B
Kissimmee, FL 34746-8814

Phone

(407) 870-5151

Fax

(407) 870-2556

NPI assigned

Jun 10, 2009

Last updated

Jun 10, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 28, 2015 through Dec 28, 2027

Medicare enrollment (NPD)

Enrolled

Practice roles

Networks

• Freedom Health HMO Network

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.

• Ata Dental Kissimmee LLC

  • General Practice Dentistry
  • Kissimmee, FL
  • NPI 1366001471
  NPD (past)
• Omar Ata, D.D.S., PA.

  • General Practice Dentistry
  • Kissimmee, FL
  • NPI 1447215876
  NPD (past)

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244592000000",
    "number": "1699901165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3192 S JOHN YOUNG PKWY",
            "address_2": "SUITE B",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347468814",
            "telephone_number": "407-870-5151",
            "fax_number": "407-870-2556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3192 S JOHN YOUNG PKWY",
            "address_2": "SUITE B",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347468814",
            "telephone_number": "407-870-5151",
            "fax_number": "407-870-2556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATA",
        "first_name": "JILL",
        "middle_name": "EDWARDS",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-10",
        "last_updated": "2009-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN18675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Astorga, MSW, RCSWI
• At Home Companion of Florida Inc.
• At Home Companion of Florida, Inc.
• At Talitha Cumi Home Care, Inc.
• Ata Dental Kissimmee LLC
• Joseph Adam Ata, D.M.D.
• Omar Ata, D.D.S.
• Tahsina Y Atiquzzaman, M.D.
• Tatyana Atkins
• Atlantic Professional Center Inc

• Dentist in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.