Juan a Mantilla MD PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME77038 Issued in FL

Legal business name

JUAN A MANTILLA MD PA

Practice address

11400 N Kendall Dr Ste 204
Miami, FL 33176-1029

Phone

(305) 279-2222

Fax

(305) 501-2031

NPI assigned

Jan 7, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Juan Alberto Mantilla, M.D.NPI 1699715292

Title

President

Phone

(305) 279-4222

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JBFFCD

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Juan Alberto Mantilla, MD

  • Internal Medicine Physician
  • Miami, FL
  • NPI 1699715292
  Medicare reassignment NPD Authorized official
• Humberto Jose Jimenez, M.D.

  • Family Medicine Physician
  • Miami, FL
  • NPI 1417278227
  Medicare reassignment NPD
• Sylvia Marie Vives-Montano, PA-C

  • Medical Physician Assistant
  • Miami, FL
  • NPI 1114168044
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1962732388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 N KENDALL DR STE 204",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331761029",
            "telephone_number": "305-279-2222",
            "fax_number": "305-501-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11400 N KENDALL DR STE 204",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331761029",
            "telephone_number": "305-279-2222",
            "fax_number": "305-501-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUAN A MANTILLA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-07",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "MANTILLA",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "ALBERTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-279-4222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME77038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266223000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• JTLC Collective LLC
• Ju Vidal Med LLC
• Juan a Bereao MD PA
• Juan a Dorado MD
• Juan a Fernandez MD PA
• Juan a Prieto Inpatient PA
• Juan a Puerto MD PA
• Juan a. Bereao, MD, PA
• Juan Alberto Prieto MD PA
• Juan B Hernandez MD

• Internal Medicine Physician in Miami, FL
• Providers in Miami, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.