Mid-Florida Gastroenterology Group P a

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME0037029 Issued in FL

Legal business name

MID-FLORIDA GASTROENTEROLOGY GROUP P A

Practice address

311 N Mangoustine Ave
Sanford, FL 32771-1098

Phone

(407) 321-4570

Fax

(407) 321-7690

NPI assigned

Dec 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lenkala Reddy Mallaiah, M.D.NPI 1891794954

Title

President

Phone

(407) 321-4570

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lenkala R Mallaiah, MD

  • Gastroenterology Physician
  • Sanford, FL
  • NPI 1891794954
  Medicare reassignment NPD Authorized official
• Shannon Turnbow, MD

  • Pulmonary Disease Physician
  • Lubbock, TX
  • NPI 1366444721
  NPD
• Susan Neal, ARNP

  • Nurse Practitioner
  • Leesburg, FL
  • NPI 1467704031
  NPD (past)
• Martin N Schnell, M.D.

  • Family Medicine Physician
  • Howey in the Hills, FL
  • NPI 1043283351
  NPD (past)
• Movva Navin Reddy, MD

  • Emergency Medicine Physician
  • Durham, NC
  • NPI 1487696399
  NPD (past)

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

{
    "created_epoch": "1198195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284940800000",
    "number": "1841474103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 N MANGOUSTINE AVE",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327711098",
            "telephone_number": "407-321-4570",
            "fax_number": "407-321-7690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N MANGOUSTINE AVE",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327711098",
            "telephone_number": "407-321-4570",
            "fax_number": "407-321-7690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-FLORIDA GASTROENTEROLOGY GROUP P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-21",
        "last_updated": "2010-09-20",
        "status": "A",
        "authorized_official_last_name": "MALLAIAH",
        "authorized_official_first_name": "LENKALA",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-321-4570",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME0037029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110047015",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "77496",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB7606",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "065414100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Sanford, FL
• Providers in Sanford, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.