Individual provider Active NPI

Angelo Rutty Espinoza

  • General Practice Physician
  • Winter Garden, FL
National Provider Identifier
1790169423
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN946 Issued in FL
Practice address
871 Vineland Rd Ste B
Winter Garden, FL 34787-3938
Phone
(407) 978-0227
NPI assigned
Jul 13, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X ACN946 FL Primary

Addresses

Primary practice location

871 Vineland Rd Ste B
Winter Garden, FL 34787-3938

Mailing address

7620 Lake Underhill Rd
Orlando, FL 32822-8223
Phone (412) 587-2022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160610000824 PR Practitioner - General Practice 5496063240 Practice locations: Mayaguez, PR
I20170919003627 FL Practitioner - General Practice 5496063240 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Laras Chronic Medical Care LLC CurrentSince Sep 15, 2017 Accepting new patients
Idr Med Florida LLC CurrentSince Apr 19, 2018 Accepting new patients
West Marion Family Practice PA CurrentSince Sep 15, 2017 Accepting new patients

Locations

2760 SE 17th St
Bldg 400
Ocala, FL 34471
Phone (352) 236-6806

8599 SW Highway 200
Ocala, FL 34481
Phone (352) 861-0043

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1790169423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7620 LAKE UNDERHILL RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328228223",
            "telephone_number": "412-587-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "871 VINELAND RD STE B",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873938",
            "telephone_number": "407-978-0227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTTY ESPINOZA",
        "first_name": "ANGELO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-13",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Garden, FL

Sources for this page

Verify at the official NPI Registry.