Individual provider Active NPI

Juan E Fernandez- Maceiro, M.D.

  • General Practice Physician
  • Kissimmee, FL
National Provider Identifier
1902052756
Registry record updated Jan 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN302 Issued in FL
Practice address
931 W Oak St
Ste 103
Kissimmee, FL 34741-4973
Phone
(407) 931-0444
Fax
(407) 962-4446
NPI assigned
Aug 13, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 17259 PR
General Practice Physician 208D00000X ACN302 FL Primary

Addresses

Primary practice location

931 W Oak St
Ste 103
Kissimmee, FL 34741-4973

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 FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20090409000087 FL Practitioner - Family PracticePractitioner - General Practice 2961559992 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1985
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

  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17259PRMDClinical Social Worker
ACN302FLMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Healthcare Associates, Inc CurrentSince Apr 9, 2015 Accepting new patients

Locations

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

3071 Michigan Ave
Kissimmee, FL 34744
Phone (407) 348-9111

Organizations & group practices 1

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 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": "1218585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516752000000",
    "number": "1902052756",
    "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": "931 W OAK ST",
            "address_2": "STE 103",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414973",
            "telephone_number": "407-931-0444",
            "fax_number": "407-962-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ- MACEIRO",
        "first_name": "JUAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-13",
        "last_updated": "2018-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "17259",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.