Individual provider Active NPI

Roberto Jose Diaz Balzac, M.D.

  • Emergency Medicine Physician
  • Orlando, FL
National Provider Identifier
1831538016
Registry record updated Jul 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME127423 Issued in FL
Practice address
7727 Lake Underhill Rd
Suite 115
Orlando, FL 32822-8224
Phone
(407) 303-8110
NPI assigned
Jun 20, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X ME127423 FL Primary

Addresses

Primary practice location

7727 Lake Underhill Rd
Suite 115
Orlando, FL 32822-8224

Mailing address

500 Winderley PL
Suite 115
Maitland, FL 32751-7247
Phone (407) 875-0555

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
I20160808000030 FL Practitioner - Emergency Medicine 0840584389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Puerto Rico School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Emergency Physicians Kang and Associates MD LLCGroup PAC ID 0143113878, 318 clinicians

Practice addresses (Care Compare)

1000 Waterman Way
Emergency Department
Tavares, FL 32778-5266
Phone (352) 253-3333

Hospital & facility affiliations

  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME127423FLMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Emergency Physicians Kang and Associates MD LLC Emergency Medicine CurrentSince Jun 20, 2016 Accepting new patients
Observation Medicine Specialists LLC Past Accepting new patients

Locations

1909 E Highway 50
Clermont, FL 34711
Phone (352) 717-3800

1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469491200000",
    "number": "1831538016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WINDERLEY PL",
            "address_2": "SUITE 115",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517247",
            "telephone_number": "407-875-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7727 LAKE UNDERHILL RD",
            "address_2": "SUITE 115",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328228224",
            "telephone_number": "407-303-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ BALZAC",
        "first_name": "ROBERTO",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-20",
        "last_updated": "2016-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME127423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.