Individual provider Active NPI

Madeleen Y Buritica, PA-C, MSPAS

  • Physician Assistant
  • Maitland, FL
National Provider Identifier
1861110470
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9116543 Issued in FL
Practice address
500 Winderley PL Ste 115
Maitland, FL 32751-7406
Phone
(407) 875-0555
NPI assigned
Aug 19, 2022
Last updated
Sep 29, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9116543 FL Primary
Emergency Medicine Physician 207P00000X STUDENT FL

Addresses

Primary practice location

500 Winderley PL Ste 115
Maitland, FL 32751-7406

Mailing address

11570 Kenley Cir
Orlando, FL 32824-5965
Phone (407) 914-9282

Other practice location 1

11570 Kenley Cir
Orlando, FL 32824-5965
Phone (407) 914-9282

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221027002740 FL Practitioner - Physician Assistant 6901273341 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9116543FLMDPhysician Assistant
STUDENTFLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Observation Medicine Specialists LLC PastSince Sep 25, 2022 Accepting new patients

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": "1660867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1861110470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11570 KENLEY CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328245965",
            "telephone_number": "407-914-9282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WINDERLEY PL STE 115",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517406",
            "telephone_number": "407-875-0555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11570 Kenley Cir",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328245965",
            "country_code": "US",
            "telephone_number": "407-914-9282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURITICA",
        "first_name": "MADELEEN",
        "middle_name": "Y",
        "credential": "PA-C, MSPAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-19",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116543",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "STUDENT",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.