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Individual provider Active NPI

Jomary Santiago Illas, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Hialeah, FL
National Provider Identifier
1720850167
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
11026344 Issued in FL
Practice address
395 W 42ND St
Hialeah, FL 33012-3914
Phone
(786) 340-7538
NPI assigned
Oct 30, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 11026344 FL
Community Health Nurse Practitioner 363LC1500X 11026344 FL
Gerontology Nurse Practitioner 363LG0600X 11026344 FL
Primary Care Nurse Practitioner 363LP2300X 11026344 FL
Acute Care Nurse Practitioner 363LA2100X 11026344 FL Primary

Addresses

Primary practice location

395 W 42ND St
Hialeah, FL 33012-3914

Mailing address

395 W 42ND St
Hialeah, FL 33012-3914
Phone (786) 340-7538

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250319002366 FL Practitioner - Nurse Practitioner 1850813833 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oak Grove Physician Services PAGroup PAC ID 8628421526, 65 clinicians

Practice addresses (Care Compare)

160 NW 170 St
North Miami Beach, FL 33169-5521
Phone (305) 651-1100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11026344FLMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Grove Physician Services, P.a. CurrentSince Feb 20, 2025 Accepting new patients

Locations

160 NW 170th St
North Miami Beach, FL 33169
Phone (305) 585-8957

200 Corporate Blvd
Lafayette, LA 70508

Organizations & group practices 1

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 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1698624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1720850167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 W 42ND ST",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330123914",
            "telephone_number": "786-340-7538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W 42ND ST",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330123914",
            "telephone_number": "786-340-7538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTIAGO ILLAS",
        "first_name": "JOMARY",
        "credential": "AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-30",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "11026344",
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "FL",
            "license": "11026344",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "11026344",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "11026344",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "11026344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.