Individual provider Active NPI

Ijlal Uddin, M.D.

  • Nephrology Physician
  • Winter Park, FL
National Provider Identifier
1760652879
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME107810 Issued in FL
Practice address
4355 Bear Gully Rd Ste 1024
Winter Park, FL 32792-9422
Phone
(407) 288-8750
Fax
(407) 647-0616
NPI assigned
Mar 4, 2008
Last updated
Dec 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X MD037977 DC
Nephrology Physician 207RN0300X ME107810 FL Primary

Addresses

Primary practice location

4355 Bear Gully Rd Ste 1024
Winter Park, FL 32792-9422

Mailing address

4355 Bear Gully Rd Ste 1024
Winter Park, FL 32792-9422
Phone (407) 288-8750

Other practice location 1

5745 Canton Cv Ste 121
Winter Springs, FL 32708
Phone (407) 288-8750

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
I20120112000363 FL Practitioner - NephrologyPractitioner - Internal Medicine 1355519141 Reassigns benefits to 1 organization
Practice locations: Winter Park, FL

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4355 Bear Gully Rd
Suite 1024
Winter Park, FL 32792-9422
Phone (407) 647-2550

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD037977DCMDNephrology Physician
ME107810FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Nephrology Hypertension & Renal Transplantation, LLC Nephrology CurrentSince Apr 1, 2019 Accepting new patients
Longwood Medical Group PA Past Accepting new patients
Cfa Kidney & Hypertension Center LLC Past Accepting new patients

Locations

174 State Road 436
Unit D102
Casselberry, FL 32707
Phone (407) 551-1601

4355 Bear Gully Rd
Ste 1024
Winter Park, FL 32792
Phone (407) 331-4115

5745 Canton Cv
Ste 121
Winter Springs, FL 32708
Phone (407) 545-6232

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1577/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1760652879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4355 BEAR GULLY RD STE 1024",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327929422",
            "telephone_number": "407-288-8750",
            "fax_number": "407-647-0616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4355 BEAR GULLY RD STE 1024",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327929422",
            "telephone_number": "407-288-8750",
            "fax_number": "407-647-0616"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5745 Canton Cv Ste 121",
            "address_purpose": "LOCATION",
            "city": "Winter Springs",
            "state": "FL",
            "postal_code": "32708",
            "country_code": "US",
            "telephone_number": "407-288-8750",
            "fax_number": "407-647-0616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UDDIN",
        "first_name": "IJLAL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-04",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "DC",
            "license": "MD037977",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME107810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Park, FL

Sources for this page

Verify at the official NPI Registry.