Individual provider Active NPI

Leomaris A Trujillo Santiago, M.D.

  • General Practice Physician
  • Kissimmee, FL
National Provider Identifier
1811139520
Registry record updated May 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN1099 Issued in FL
Practice address
222 Broadway Unit 202
Kissimmee, FL 34741-5760
Phone
(787) 276-7043
Fax
(787) 759-8411
NPI assigned
Mar 26, 2009
Last updated
May 30, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 17441 PR
General Practice Physician 208D00000X ACN1099 FL Primary

Addresses

Primary practice location

222 Broadway Unit 202
Kissimmee, FL 34741-5760

Mailing address

222 Broadway Unit 202
Kissimmee, FL 34741-5760
Phone (787) 276-7043

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
I20190711000905 FL Practitioner - General Practice 6204161367 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17441PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kashyap Patel MD PA CurrentSince Jun 1, 2021 Accepting new patients
Volusia & Flagler OB-GYN PA Past Accepting new patients

Locations

325 Clyde Morris Blvd
Ste 340
Ormond Beach, FL 32174
Phone (386) 615-8971

598 Sterthaus Dr
#C
Ormond Beach, FL 32174
Phone (386) 672-9683

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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": "1238025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559174400000",
    "number": "1811139520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 BROADWAY UNIT 202",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347415760",
            "telephone_number": "787-276-7043",
            "fax_number": "787-759-8411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 BROADWAY UNIT 202",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347415760",
            "telephone_number": "787-276-7043",
            "fax_number": "787-759-8411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRUJILLO SANTIAGO",
        "first_name": "LEOMARIS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-26",
        "last_updated": "2019-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "17441",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.