NPIMap

Organization Active NPI

Progressive Pediatrics of Orlando PA

  • Pediatrics Physician
  • Longwood, FL
National Provider Identifier
1992730550
Registry record updated May 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME54968 Issued in FL
Legal business name
PROGRESSIVE PEDIATRICS OF ORLANDO PA
Practice address
521 W State Road 434
Suite 101
Longwood, FL 32750
Phone
(407) 830-5437
Fax
(407) 834-4907
NPI assigned
Jul 12, 2006
Last updated
May 14, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2008

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

Authorized official

Name
Alfonso Mireles, MDNPI 1427055532
Title
Owner
Phone
(407) 830-5437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X ME54968 FL Primary

Addresses

Primary practice location

521 W State Road 434
Suite 101
Longwood, FL 32750

Mailing address

PO Box 520879
Longwood, FL 32752-0879
Phone (407) 830-5437

Other identifiers 1

IdentifierTypeStateIssuer
272040000MedicaidFL

National Provider Directory

National Provider Directory

Locations

521 W State Road 434
Ste 101
Longwood, FL 32750
Phone (407) 830-5437

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1992730550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 520879",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327520879",
            "telephone_number": "407-830-5437",
            "fax_number": "407-834-4907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W STATE ROAD 434",
            "address_2": "SUITE 101",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "32750",
            "telephone_number": "407-830-5437",
            "fax_number": "407-834-4907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE PEDIATRICS OF ORLANDO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "MIRELES",
        "authorized_official_first_name": "ALFONSO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-830-5437",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME54968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272040000",
            "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 May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.