Active NPI
Mulugeta Z Fissha, MD
- Interventional Cardiology Physician
- Lake Mary, FL
National Provider Identifier
1790827715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Cardiology Physician
- License
- ME131385
- Practice address
- 910 Williston Park PT Ste 1000
Lake Mary, FL 32746-2163 - Phone
- (407) 833-8028
- NPI assigned
- Feb 13, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 04-34999 | KS | |
| Cardiovascular Disease Physician | 207RC0000X | 04-34999 | KS | |
| Interventional Cardiology Physician | 207RI0011X | 04-34999 | KS | |
| Interventional Cardiology Physician | 207RI0011X | ME131385 | FL | Primary |
Addresses
Primary practice location
910 Williston Park PT Ste 1000
Lake Mary, FL 32746-2163
Mailing address
910 Williston Park PT Ste 1000
Lake Mary, FL 32746-2163
Phone (620) 794-1962
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200862580A | Medicaid | KS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | http://thecvcenter.com/ | Health Information Exchange (HIE) |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Interventional Cardiology
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1055 Saxon Blvd
Orange City, FL 32763-8468
Phone (386) 917-5000
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Coronary angioplasty and stenting | 1-10 |
| Pacemaker insertion or repair | 17 |
| Leg revascularization (restoring blood flow) | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-34999 | KS | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Volusia Healthcare Corporation | Current | Accepting new patients | |
| Southwest Volusia Healthcare Corporation | Internal Medicine | Current | Accepting new patients |
| Florida Hospital Healthcare Partners, Inc | Internal Medicine | Current | Accepting new patients |
| Central Florida Cardiology Interpretations LLC | Current | Accepting new patients |
Locations
910 Williston Park Pt
Ste 1000
Lake Mary, FL 32746
Phone (407) 803-8028
1035 Town Center Dr
Orange City, FL 32763
Phone (386) 775-8229
1055 Saxon Blvd
Orange City, FL 32763
Phone (386) 917-5000
1061 Medical Center Dr
Ste 203
Orange City, FL 32763
Phone (386) 774-4200
60 Memorial Medical Pkwy
Palm Coast, FL 32164
Phone (385) 586-2000
1401 W Seminole Blvd
Sanford, FL 32771
Phone (317) 805-2316
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Interoperability endpoints
- mfissha70831@adventhealth.direct-ci.com
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.
-
- Internal Medicine Physician
- Daytona Beach, FL
- NPI 1780100529
-
- Cardiology Technician
- Sanford, FL
- NPI 1780807412
-
- Community/Retail Pharmacy
- Orange City, FL
- NPI 1568254159
-
- Internal Medicine Physician
- Orange City, FL
- NPI 1902095078
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Orlando, FL
- NPI 1306938071
-
- Clinical Medical Laboratory
- Orlando, FL
- NPI 1801569728
Hospital
-
- General Acute Care Hospital
- Daytona Beach, FL
- NPI 1063426823
-
- General Acute Care Hospital
- Deland, FL
- NPI 1649367269
-
- General Acute Care Hospital
- Orange City, FL
- NPI 1700978558
-
- Internal Medicine Physician
- Orange City, FL
- NPI 1902095078
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603324800000",
"number": "1790827715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "910 WILLISTON PARK PT STE 1000",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327462163",
"telephone_number": "620-794-1962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "910 WILLISTON PARK PT STE 1000",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327462163",
"telephone_number": "407-833-8028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISSHA",
"first_name": "MULUGETA",
"middle_name": "Z",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2020-10-22",
"certification_date": "2020-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "KS",
"license": "04-34999",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "KS",
"license": "04-34999",
"primary": false
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "KS",
"license": "04-34999",
"primary": false
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "FL",
"license": "ME131385",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200862580A",
"state": "KS"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "http://thecvcenter.com/",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "910 Williston Park Pt Ste 1000",
"city": "Lake Mary",
"state": "FL",
"country_code": "US",
"postal_code": "327462163",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.