Juan Carlos Ibarra Moreno, SA-C

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

13-514 Issued in FL

Practice address

6150 Diamond Centre CT Unit 1200
Fort Myers, FL 33912-7135

Phone

(239) 344-9786

Fax

(239) 344-9215

NPI assigned

Nov 15, 2016

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24814/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir4.healow.com/fhir/r4/BDHJCD

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.

• Sunburst Cardiology LLC

  • Cardiovascular Disease Physician
  • Fort Myers, FL
  • NPI 1356011357
  NPD (past)

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

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586476800000",
    "number": "1780126219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6150 DIAMOND CENTRE CT # 1300",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124367",
            "telephone_number": "239-344-9786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6150 DIAMOND CENTRE CT UNIT 1200",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339127135",
            "telephone_number": "239-344-9786",
            "fax_number": "239-344-9215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBARRA MORENO",
        "first_name": "JUAN",
        "middle_name": "CARLOS",
        "credential": "SA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-15",
        "last_updated": "2020-04-10",
        "certification_date": "2020-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "FL",
            "license": "13-514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pierre R Hyppolite, MD
• Jillian Hysko, PA
• Megan Iannone, CCC-SLP
• Marie Ibach, PT
• Daniyami Ibarra Melendez, LMT
• Mitzi Melaine Ibarra
• Bernadette Olayinka Ibitokun, MD
• Marinette Ibrahim, RPH, B.PHARM, CPH
• Stephanie M Ibus, CCP
• Emily Ickes

• Surgical Assistant in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Surgical Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.