NPIMap

Individual provider Active NPI

Juan Otheguy, MD

  • Specialist
  • Trinity, FL
National Provider Identifier
1992760557
Registry record updated Apr 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME-62352 Issued in FL
Practice address
2075 Little Rd
Trinity, FL 34655-4421
Phone
(727) 375-5520
Fax
(727) 375-1463
NPI assigned
Apr 18, 2006
Last updated
Apr 27, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME-62352 FL Primary

Addresses

Primary practice location

2075 Little Rd
Trinity, FL 34655-4421

Mailing address

2075 Little Rd
Trinity, FL 34655-4421
Phone (727) 375-5520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070622000245 FL Practitioner - Urology 1456322817 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University Central del Caribe Escuela de Medicina, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urology Professionals LLLPGroup PAC ID 0840399440, 2 clinicians

Practice addresses (Care Compare)

2075 Little Rd
Trinity, FL 34655-4421
Phone (727) 375-5520

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME-62352FLMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Urology Professionals LLLP Specialist CurrentSince Apr 1, 2007 Accepting new patients
Interventional Cardiac Consultants PLC PastSince Aug 1, 2026 Accepting new patients
Gonzalez & Michael Medical Assoc., P.a. Past Accepting new patients

Locations

2075 Little Rd
Trinity, FL 34655
Phone (727) 375-5520

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1245/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/BBEDAA

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461715200000",
    "number": "1992760557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2075 LITTLE RD",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346554421",
            "telephone_number": "727-375-5520",
            "fax_number": "727-375-1463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2075 LITTLE RD",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346554421",
            "telephone_number": "727-375-5520",
            "fax_number": "727-375-1463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTHEGUY",
        "first_name": "JUAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2016-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME-62352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trinity, FL

Sources for this page

Verify at the official NPI Registry.