Individual provider Active NPI

Idaylis Morono Ponce, PHYSICIAN/MD

  • Family Medicine Physician
  • Miami, FL
National Provider Identifier
1932221561
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME102072 Issued in FL
Practice address
8352 SW 40 Street
Miami, FL 33155-3354
Phone
(305) 225-0707
Fax
(888) 208-1644
NPI assigned
Apr 4, 2007
Last updated
Aug 9, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME102072 FL Primary

Addresses

Primary practice location

8352 SW 40 Street
Miami, FL 33155-3354

Mailing address

8352 SW 40 Street
Miami, FL 33155-3354
Phone (305) 225-0707

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
I20090223000198 FL Practitioner - Family Practice 2961567102 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premier Value Family Medicine LLCGroup PAC ID 9638306475, 2 clinicians

Practice addresses (Care Compare)

8348 SW Bird Rd
Miami, FL 33155-3354

8352 SW 40TH St
Miami, FL 33155-3354
Phone (305) 225-0707

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME102072FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Value Family Medicine LLC Family Medicine CurrentSince Sep 26, 2013 Accepting new patients

Locations

8348 SW Bird Rd
Miami, FL 33155
Phone (305) 225-0707

8352 SW 40th St
Miami, FL 33155
Phone (305) 225-0707

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1932221561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8352 SW 40 STREET",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553354",
            "telephone_number": "305-225-0707",
            "fax_number": "888-208-1644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8352 SW 40 STREET",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553354",
            "telephone_number": "305-225-0707",
            "fax_number": "888-208-1644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORONO PONCE",
        "first_name": "IDAYLIS",
        "name_prefix": "Dr.",
        "credential": "PHYSICIAN/MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-04",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME102072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.