Individual provider Active NPI

Angel Ortiz de Jesus, MD

  • General Practice Physician
  • Orlando, FL
National Provider Identifier
1881158061
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
21189 Issued in PR
Practice address
708 E Colonial Dr Ste 200
Orlando, FL 32803-4652
Phone
(407) 895-9255
NPI assigned
Jan 22, 2019
Last updated
May 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 21189 PR Primary

Addresses

Primary practice location

708 E Colonial Dr Ste 200
Orlando, FL 32803-4652

Mailing address

308 W Bass St
Kissimmee, FL 34741-5001
Phone (407) 483-8801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190723000605 PR Practitioner - General Practice 7810223377 Reassigns benefits to 2 organizations
I20220119001473 FL Practitioner - General Practice 7810223377 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Healthcare Associates, IncGroup PAC ID 4183606601, 16 clinicians

Practice addresses (Care Compare)

308 W Bass St
Kissimmee, FL 34741-5001
Phone (407) 933-1760

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21189PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Healthcare Associates, Inc CurrentSince Feb 1, 2022 Accepting new patients
Integrate Community Health System CurrentSince Sep 1, 2020 Accepting new patients
Sur-Med Medical Corp CurrentSince Feb 1, 2019 Accepting new patients
Integrate Community Health System Current Accepting new patients
Integrate Community Health System, Inc. CurrentSince Sep 1, 2020 Accepting new patients
Sur-Med Medical Corp. CurrentSince Feb 1, 2019 Accepting new patients

Locations

308 W Bass St
Kissimmee, FL 34741
Phone (407) 483-8801

8 Calle Colon Pacheco
Salinas, PR 00751
Phone (787) 824-1100

Organizations & group practices 6

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.

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": "1548115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1881158061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 W BASS ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347415001",
            "telephone_number": "407-483-8801",
            "fax_number": "407-483-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 E COLONIAL DR STE 200",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328034652",
            "telephone_number": "407-895-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ DE JESUS",
        "first_name": "ANGEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-22",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "21189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.