NPIMap

Individual provider Active NPI

Mariam Javed Mayet-Khan, DO

  • Family Medicine Physician
  • Mount Dora, FL
National Provider Identifier
1851897367
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS17479 Issued in FL
Practice address
19735 US Highway 441 FL 1
Mount Dora, FL 32757-2204
Phone
(352) 735-5700
NPI assigned
Apr 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS17479 FL Primary

Addresses

Primary practice location

19735 US Highway 441 FL 1
Mount Dora, FL 32757-2204

Mailing address

19735 US Highway 441 FL 1
Mount Dora, FL 32757-2204
Phone (352) 735-5700

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
I20210721002282 FL Practitioner - Family Practice 5395177216 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Nova Southeastern College of Osteo Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adventhealth Primary Care Network IncGroup PAC ID 1557722410, 428 clinicians

Practice addresses (Care Compare)

19735 US Hwy 441
FL 1
Mount Dora, FL 32757-2204
Phone (352) 735-5700

661 E Altamonte Dr
Suite 115
Altamonte Springs, FL 32701-5102
Phone (407) 831-4040

Hospital & facility affiliations

  • Pinnacle Home Care of the Villages Inc Home health agency, The Villages, FL, CCN 109702
  • Adventhealth Home Health Home health agency, Leesburg, FL, CCN 107155
  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
  • Adventhealth Waterman Hospital, Tavares, FL, CCN 100057
  • Adventhealth Daytona Beach Hospital, Daytona Beach, FL, CCN 100068
  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007
  • Edgewater at Waterman Village Nursing home, Mount Dora, FL, CCN 105796

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS17479FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc CurrentSince Aug 30, 2021 Accepting new patients
Florida Hospital Medical Group Inc Family Medicine CurrentSince Aug 30, 2021 Accepting new patients
Adventhealth Primary Care Network Inc Family Medicine CurrentSince Nov 1, 2023 Accepting new patients

Locations

661 E Altamonte Dr
Ste 115
Altamonte Springs, FL 32701
Phone (407) 831-4040

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

19735 US Highway 441
Fl 1
Mount Dora, FL 32757
Phone (352) 735-5700

1749 David Walker Dr
Tavares, FL 32778
Phone (352) 742-1760

Interoperability endpoints

  • Direct secure messaging: mmayetkhan73726@adventhealth.direct-ci.com

Organizations & group practices 3

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 12

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": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1851897367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19735 US HIGHWAY 441 FL 1",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327572204",
            "telephone_number": "352-735-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19735 US HIGHWAY 441 FL 1",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327572204",
            "telephone_number": "352-735-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYET-KHAN",
        "first_name": "MARIAM",
        "middle_name": "JAVED",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-03",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS17479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Dora, FL

Sources for this page

Verify at the official NPI Registry.