Individual provider Active NPI

Javier Mouriz, PHD

  • Psychologist
  • Lady Lake, FL
National Provider Identifier
1992256739
Registry record updated Oct 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY9520 Issued in FL
Practice address
804 Co Rd 466
Lady Lake, FL 32159
Phone
(352) 978-1591
NPI assigned
Oct 17, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY9520 FL Primary

Addresses

Primary practice location

804 Co Rd 466
Lady Lake, FL 32159

Mailing address

35107 Riverside CT
Leesburg, FL 34788-3135
Phone (352) 978-1591

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170302001520 FL Practitioner - Clinical Psychologist 6901186055 Practice locations: Orlando, FL; Wildwood, FL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

601 Webster St
Wildwood, FL 34785-3828
Phone (352) 694-8000

6735 Conroy Rd
Suite 405
Orlando, FL 32835-3567
Phone (352) 978-1591

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PY9520FLMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Horizon West Neurobehavioral Health 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.

NPI Registry JSON

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476662400000",
    "number": "1992256739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35107 RIVERSIDE CT",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347883135",
            "telephone_number": "352-978-1591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 CO RD 466",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "32159",
            "telephone_number": "352-978-1591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOURIZ",
        "first_name": "JAVIER",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY9520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lady Lake, FL

Sources for this page

Verify at the official NPI Registry.