Active NPI
Rylan Ciccarello, MD
- Psychiatry Physician
- Longwood, FL
National Provider Identifier
1972130144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- ME169521
- Practice address
- 455 W Warren Ave
Longwood, FL 32750-4038 - Phone
- (407) 262-2220
- Fax
- (407) 834-5011
- NPI assigned
- Mar 26, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | TRN30221 | FL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | ME169521 | FL | Primary |
Addresses
Primary practice location
455 W Warren Ave
Longwood, FL 32750-4038
Mailing address
455 W Warren Ave
Longwood, FL 32750-4038
Phone (407) 262-2220
Other practice location 1
1147 NW 64th Ter
Gainesville, FL 32605-4218
Phone (352) 333-5982
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 123252500 | Medicaid | FL |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
455 W Warren Ave
Longwood, FL 32750-4038
Phone (407) 262-2220
Hospital & facility affiliations
- Orlando Health-Health Central Hospital
- Orlando Health South Lake Hospital
- Orlando Health Bayfront Hospital
- Orlando Regional Rehab Institute
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME169521 | FL | MD | Psychiatry Physician |
| TRN30221 | FL | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orlando Health Medical Group Inc | Current | Accepting new patients | |
| Orlando Health Medical Group Inc | Current | Accepting new patients |
Locations
455 W Warren Ave
Longwood, FL 32750
Phone (407) 260-0551
32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820
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 and National Provider Directory roles.
-
- Internal Medicine Physician
- Orlando, FL
- NPI 1669429577
-
- Durable Medical Equipment & Medical Supplies
- Winter Park, FL
- NPI 1265019541
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- St Petersburg, FL
- NPI 1154399749
-
- General Acute Care Hospital
- Ocoee, FL
- NPI 1033475959
-
- General Acute Care Hospital
- Orlando, FL
- NPI 1184709057
Inpatient rehabilitation facility
-
- Rehabilitation Hospital Unit
- Ocoee, FL
- NPI 1801503313
Inpatient rehabilitation facility
-
- General Acute Care Hospital
- Clermont, FL
- NPI 1336221019
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722902400000",
"number": "1972130144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 W WARREN AVE",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327504038",
"telephone_number": "407-262-2220",
"fax_number": "407-834-5011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 W WARREN AVE",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327504038",
"telephone_number": "407-262-2220",
"fax_number": "407-834-5011"
}
],
"practiceLocations": [
{
"address_1": "1147 NW 64th Ter",
"address_purpose": "LOCATION",
"city": "Gainesville",
"state": "FL",
"postal_code": "326054218",
"country_code": "US",
"telephone_number": "352-333-5982",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CICCARELLO",
"first_name": "RYLAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-26",
"last_updated": "2024-08-06",
"certification_date": "2024-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "FL",
"license": "TRN30221",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "FL",
"license": "ME169521",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "123252500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longwood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.