NPIMap

Individual provider Active NPI

Shobana Sivan, MD

  • Nephrology Physician
  • Winter Park, FL
National Provider Identifier
1922365485
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME151158 Issued in FL
Practice address
807 S Orlando Ave Ste C
Winter Park, FL 32789-4870
Phone
(407) 894-4693
NPI assigned
Apr 20, 2012
Last updated
Aug 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME151158 FL
Nephrology Physician 207RN0300X ME151158 FL Primary

Addresses

Primary practice location

807 S Orlando Ave Ste C
Winter Park, FL 32789-4870

Mailing address

807 S Orlando Ave Ste C
Winter Park, FL 32789-4870
Phone (407) 894-4693

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
I20210712001478 FL Practitioner - NephrologyPractitioner - Internal Medicine 4688076821 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates of Central Florida, P.a.Group PAC ID 2567359375, 34 clinicians

Practice addresses (Care Compare)

2501 N Orange Ave
Suite 537N
Orlando, FL 32804-4674
Phone (407) 894-4693

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME151158FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Miami Current Accepting new patients
University of Miami Internal Medicine CurrentSince Jun 1, 2021 Accepting new patients
Nephrology Associates of Central Florida, P.a. Nephrology CurrentSince Aug 1, 2024 Accepting new patients
Central Florida Inpatient Medicine LLC Internal Medicine CurrentSince Oct 1, 2024 Accepting new patients
University of Miami Nephrology CurrentSince Jun 1, 2021 Accepting new patients
Renal Access of Central Florida LLC Nephrology PastSince Jun 2, 2024 Accepting new patients

Locations

4800 NE 20th Ter
Ste 201
Ft Lauderdale, FL 33308
Phone (305) 892-4000

525 Technology Park
Ste 109
Lake Mary, FL 32746
Phone 4076472346 ext. 111

1400 NW 12th Ave
Miami, FL 33136
Phone (305) 325-5416

1611 NW 12th Ave
Miami, FL 33136
Phone (305) 585-6226

1801 NW 9th Ave
Fl 6
Miami, FL 33136
Phone (305) 355-5006

2501 N Orange Ave
Ste 537N
Orlando, FL 32804
Phone (407) 894-4693

807 S Orlando Ave
Ste C
Winter Park, FL 32789
Phone (407) 894-4693

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: ssivan80685@direct.med.miami.edu

Organizations & group practices 7

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 5

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": "1334880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1922365485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 S ORLANDO AVE STE C",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894870",
            "telephone_number": "407-894-4693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 S ORLANDO AVE STE C",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894870",
            "telephone_number": "407-894-4693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVAN",
        "first_name": "SHOBANA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-20",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME151158",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME151158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Park, FL

Sources for this page

Verify at the official NPI Registry.