NPIMap

Organization Active NPI

Florida Otolaryngology Group, P.a.

  • Otolaryngology Physician
  • Winter Park, FL
National Provider Identifier
1740368802
Registry record updated Dec 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
FLORIDA OTOLARYNGOLOGY GROUP, P.A.
Practice address
7251 University Blvd
Suite 300
Winter Park, FL 32792-8659
Phone
(407) 677-0099
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2009

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

Authorized official

Name
Ms. Michelle Stephanie Makuta
Title
Office Manager
Phone
(407) 351-0675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

7251 University Blvd
Suite 300
Winter Park, FL 32792-8659

Mailing address

7251 University Blvd
Suite 300
Winter Park, FL 32792-8659
Phone (407) 677-0099

Other identifiers 1

IdentifierTypeStateIssuer
060823800MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050614000474 FL Part B Supplier - Clinic/Group Practice 7618911306 Receives reassigned benefits from 16 practitioners
Practice locations: Kissimmee, FL; Orlando, FL; Winter Park, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1024813Florida Otolaryngology Group PA7251 University Blvd Ste 300, Winter Park, FL 32792Certificate of waiverNov 7, 2027

National Provider Directory

National Provider Directory

Locations

1781 Park Center Dr
Ste 210
Orlando, FL 32835
Phone (407) 351-0675

7251 University Blvd
Ste 300
Winter Park, FL 32792
Phone (407) 677-0099

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260230400000",
    "number": "1740368802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7251 UNIVERSITY BLVD",
            "address_2": "SUITE 300",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327928659",
            "telephone_number": "407-677-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7251 UNIVERSITY BLVD",
            "address_2": "SUITE 300",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327928659",
            "telephone_number": "407-677-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA OTOLARYNGOLOGY GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2009-12-08",
        "status": "A",
        "authorized_official_last_name": "MAKUTA",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "STEPHANIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "407-351-0675",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060823800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.