Individual provider Active NPI

Carlos Diaz, PA

  • Psychiatric/Mental Health Nurse Practitioner
  • Hialeah, FL
National Provider Identifier
1770125098
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
PA9112604 Issued in FL
Practice address
2793 W 72ND PL
Hialeah, FL 33016-5436
Phone
(786) 506-1786
NPI assigned
Oct 9, 2019
Last updated
Sep 2, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9112604 FL
Adult Psychiatric/Mental Health Clinical Nurse Specialist 364SP0809X PA9112604 FL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X PA9112604 FL Primary

Addresses

Primary practice location

2793 W 72ND PL
Hialeah, FL 33016-5436

Mailing address

2793 W 72ND PL
Hialeah, FL 33016-5436
Phone (786) 506-1786

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201009001396 FL Practitioner - Physician Assistant 3577983741 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1150 NW 72ND Ave
Suite 640
Miami, FL 33126-1921

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Benessere Medical Institute LLC Physician Assistant Past Accepting new patients
Benessere Healthcare Limited Liability Company Past Accepting new patients

Networks

  • HealthSun Health Plans Network

Interoperability endpoints

  • Direct secure messaging: carlos.diaz@496.emedpractice.direct-ci.com

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1570579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756771200000",
    "number": "1770125098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2793 W 72ND PL",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330165436",
            "telephone_number": "786-506-1786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2793 W 72ND PL",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330165436",
            "telephone_number": "786-506-1786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "CARLOS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-09",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112604",
            "primary": false
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "FL",
            "license": "PA9112604",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "PA9112604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.