NPIMap

Individual provider Active NPI

Ukonu Ejie, MD

  • Infectious Disease Physician
  • Daytona Beach, FL
National Provider Identifier
1790761500
Registry record updated Feb 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
ME86706 Issued in FL
Practice address
104 Lacosta LN
Suite 120
Daytona Beach, FL 32114-8159
Phone
(386) 274-1966
Fax
(386) 274-1964
NPI assigned
Dec 22, 2005
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

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.

Hospital & facility affiliations 10

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

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Infectious Diseases of Mid-Florida, PA 4 clinicians

Practice addresses (Care Compare)

290 Clyde Morris Blvd
Suite D2
Ormond Beach, FL 32174-8204
Phone (386) 265-1021

Hospital & facility affiliations

  • Trilogy Home Healthcare Home health agency, Jacksonville, FL, CCN 107689
  • Concierge Home Care Home health agency, Port Orange, FL, CCN 687137
  • Adventhealth Daytona Beach Hospital, Daytona Beach, FL, CCN 100068
  • AdventHealth Palm Coast Hospital, Palm Coast, FL, CCN 100118
  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007
  • Adventhealth Palm Coast Parkway Hospital, Palm Coast, FL, CCN 100363
  • Adventhealth New Smyrna Beach Hospital, New Smyrna Beach, FL, CCN 100014
  • Adventhealth Daytona Beach Inpatient rehabilitation facility, Daytona Beach, FL, CCN 10T068

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060207000162 FL Practitioner - Internal MedicinePractitioner - Infectious Disease 5395759880 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Infectious Diseases of Mid-Florida, PA Infectious Disease CurrentSince Jan 16, 2006 Accepting new patients

Locations

104 Lacosta Ln
Ste 120
Daytona Beach, FL 32114
Phone (386) 274-0341

290 Clyde Morris Blvd
Ste D2
Ormond Beach, FL 32174
Phone (386) 265-1021

290 Clyde Morris Blvd
Ormond Beach, FL 32174
Phone (386) 615-6642

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X ME86706 FL Primary

Addresses

NPPES NPI Registry

Primary practice location

104 Lacosta LN
Suite 120
Daytona Beach, FL 32114-8159

Mailing address

104 Lacosta LN
Suite 120
Daytona Beach, FL 32114-8159
Phone (386) 274-1966

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 7, 2013.

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360195200000",
    "number": "1790761500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 LACOSTA LN",
            "address_2": "SUITE 120",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321148159",
            "telephone_number": "386-274-1966",
            "fax_number": "386-274-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 LACOSTA LN",
            "address_2": "SUITE 120",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321148159",
            "telephone_number": "386-274-1966",
            "fax_number": "386-274-1964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EJIE",
        "first_name": "UKONU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2013-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "FL",
            "license": "ME86706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.