Individual provider Active NPI

Mario Cucchiarella, M.D.

  • Internal Medicine Physician
  • Port Orange, FL
National Provider Identifier
1790756765
Registry record updated Jun 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0047726 Issued in FL
Practice address
740 Dunlawton Ave
Ste. 200
Port Orange, FL 32127-4239
Phone
(386) 763-1000
Fax
(386) 763-0507
NPI assigned
Jan 30, 2006
Last updated
Jun 11, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME0047726 FL Primary

Addresses

Primary practice location

740 Dunlawton Ave
Ste. 200
Port Orange, FL 32127-4239

Mailing address

PO Box 9671
Daytona Beach, FL 32120-9671
Phone (386) 676-7130

Other identifiers 4

IdentifierTypeStateIssuer
ME0047726OtherFLVHN
14596OtherFLBCBS
267212000MedicaidFL
1790756765OtherFLTRICARE

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
I20090819000451 FL Practitioner - Internal Medicine 6103970561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Health Care Plan IncGroup PAC ID 9436201233, 97 clinicians

Practice addresses (Care Compare)

740 Dunlawton Ave
Suite 200
Port Orange, FL 32127-4240
Phone (386) 763-1000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0047726FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Health Care Plan, Inc CurrentSince Feb 7, 2009 Accepting new patients
Florida Health Care Plan, Inc CurrentSince Feb 7, 2009 Accepting new patients

Locations

1340 Ridgewood Ave
Holly Hill, FL 32117
Phone (386) 676-7100

309 Palm Coast Pkwy NE
Palm Coast, FL 32137
Phone (386) 445-7073

740 Dunlawton Ave
Ste 200
Port Orange, FL 32127
Phone (386) 763-1000

Interoperability endpoints

  • Direct secure messaging: mariocucchiarella@fhcpfl.allscriptsdirect.net

Organizations & group practices 2

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1790756765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9671",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321209671",
            "telephone_number": "386-676-7130",
            "fax_number": "386-676-7125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 DUNLAWTON AVE",
            "address_2": "STE. 200",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274239",
            "telephone_number": "386-763-1000",
            "fax_number": "386-763-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUCCHIARELLA",
        "first_name": "MARIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0047726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VHN",
            "identifier": "ME0047726",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "14596",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267212000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1790756765",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

Verify at the official NPI Registry.