NPIMap

Individual provider Active NPI

Eduardo Ramon Diaz, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Altamonte Springs, FL
National Provider Identifier
1902043771
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
ME103393 Issued in FL
Practice address
989 Orienta Ave
Altamonte Springs, FL 32701-5603
Phone
(407) 260-0166
Fax
(407) 544-2028
NPI assigned
Jan 14, 2009
Last updated
Aug 20, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME103393 FL
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X ME103393 FL
Geriatric Medicine (Family Medicine) Physician 207QG0300X ME103393 FL Primary

Addresses

Primary practice location

989 Orienta Ave
Altamonte Springs, FL 32701-5603

Mailing address

PO Box 2153 Dept 40339
Birmingham, AL 35287-9387
Phone (706) 271-0100

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
I20100506000853 FL Practitioner - Geriatric MedicinePractitioner - Family Practice 6305974601 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Life Care Physician Services LLCGroup PAC ID 5395861306, 18 clinicians

Practice addresses (Care Compare)

989 Orienta Ave
Altamonte Springs, FL 32701-5603
Phone (407) 831-3446

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME103393FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Life Care Physician Services, LLC Geriatric Medicine CurrentSince Jun 1, 2011 Accepting new patients
The Mayflower Retirement Center, Inc. CurrentSince Mar 22, 2010 Accepting new patients

Locations

989 Orienta Ave
Altamonte Springs, FL 32701
Phone (407) 831-3446

3850 Williams Rd
Estero, FL 33928
Phone (239) 495-1935

606 Sheridan Rd
Melbourne, FL 32901
Phone (321) 613-8199

2800 SW 41st St
Ocala, FL 34474
Phone (352) 291-4600

175 Villa Nueva Ave NE
Palm Bay, FL 32907
Phone (313) 574-2965

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.

Hospital & facility affiliations 7

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": "1231891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1902043771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2153 DEPT 40339",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352879387",
            "telephone_number": "706-271-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "989 ORIENTA AVE",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327015603",
            "telephone_number": "407-260-0166",
            "fax_number": "407-544-2028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "EDUARDO",
        "middle_name": "RAMON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-01-14",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME103393",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "FL",
            "license": "ME103393",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME103393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Altamonte Springs, FL

Sources for this page

Verify at the official NPI Registry.