Active NPI
Mai Thi Truc Phung, MD
- Neonatal-Perinatal Medicine Physician
- Orlando, FL
National Provider Identifier
1912114216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal-Perinatal Medicine Physician
- License
- ME98813
- Practice address
- 83 W Miller St
Orlando, FL 32806-2031 - Phone
- (407) 841-5218
- Fax
- (407) 649-6939
- NPI assigned
- May 17, 2007
- Last updated
- Jun 27, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal-Perinatal Medicine Physician | 2080N0001X | ME98813 | FL | Primary |
Addresses
Primary practice location
83 W Miller St
Orlando, FL 32806-2031
Mailing address
1500 Concord Ter
Sunrise, FL 33323-2815
Phone (800) 243-3839
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 278518800 | Medicaid | FL |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170925002953 | FL | Practitioner - Pediatric Medicine | 4284912080 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403827200000",
"number": "1912114216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 CONCORD TER",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333232815",
"telephone_number": "800-243-3839",
"fax_number": "954-858-0404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "83 W MILLER ST",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328062031",
"telephone_number": "407-841-5218",
"fax_number": "407-649-6939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHUNG",
"first_name": "MAI",
"middle_name": "THI TRUC",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2014-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "FL",
"license": "ME98813",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "278518800",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.