Individual provider Active NPI

Jonathan Alba, DO

  • Pediatric Critical Care Medicine Physician
  • Orlando, FL
National Provider Identifier
1962930685
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
OS16710 Issued in FL
Practice address
92 W Miller St
Orlando, FL 32806-2032
Phone
(321) 841-5104
NPI assigned
May 25, 2017
Last updated
Sep 27, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 16710 FL
Pediatrics Physician 208000000X 9016 GA
Pediatric Critical Care Medicine Physician 2080P0203X 16710 FL
Pediatric Critical Care Medicine Physician 2080P0203X OS16710 FL Primary

Addresses

Primary practice location

92 W Miller St
Orlando, FL 32806-2032

Mailing address

92 W Miller St
Orlando, FL 32806-2032
Phone (321) 841-5104

Other practice location 1

1120 15th St
Augusta, GA 30912-0004
Phone (954) 446-4770

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
I20241008001747 FL Practitioner - Critical Care (Intensivists) 1052842598 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

92 W Miller St
Orlando, FL 32806-2032
Phone (321) 841-4607

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9016GAMDPediatrics Physician
16710FLMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Sep 1, 2024 Accepting new patients
Orlando Health Medical Group Inc Pediatrics CurrentSince Sep 1, 2024 Accepting new patients

Locations

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

92 W Miller St
Orlando, FL 32806
Phone (321) 841-4607

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1495670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1962930685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 W MILLER ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062032",
            "telephone_number": "321-841-5104",
            "fax_number": "321-841-6871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 W MILLER ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062032",
            "telephone_number": "321-841-5104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 15th St",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309120004",
            "country_code": "US",
            "telephone_number": "954-446-4770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALBA",
        "first_name": "JONATHAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-25",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "16710",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "9016",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "FL",
            "license": "16710",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "FL",
            "license": "OS16710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.