Active NPI
Maria J Villa, D.O.
- Family Medicine Physician
- Immokalee, FL
National Provider Identifier
1952392631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS6128
- Practice address
- 1454 Madison Ave W
Immokalee, FL 34142-2200 - Phone
- (239) 658-3000
- Fax
- (239) 658-3199
- NPI assigned
- Nov 2, 2005
- Last updated
- Jun 16, 2015
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS6128 | FL | Primary |
Addresses
Primary practice location
1454 Madison Ave W
Immokalee, FL 34142-2200
Mailing address
1454 Madison Ave W
Immokalee, FL 34142-2200
Phone (239) 658-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 374731000 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6128 | FL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Centers of Southwest Florida, Inc. | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434412800000",
"number": "1952392631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1454 MADISON AVE W",
"city": "IMMOKALEE",
"state": "FL",
"postal_code": "341422200",
"telephone_number": "239-658-3000",
"fax_number": "239-658-3199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1454 MADISON AVE W",
"city": "IMMOKALEE",
"state": "FL",
"postal_code": "341422200",
"telephone_number": "239-658-3000",
"fax_number": "239-658-3199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLA",
"first_name": "MARIA",
"middle_name": "J",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-02",
"last_updated": "2015-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "OS6128",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "374731000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Immokalee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.