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EBENEZER MEDICAL CENTER ORLANDO CORP.
NPI 1265178131
General Practice in Kissimmee, FL

Active since May 12, 2022CLIA 10D2275504 · Waiver
845 E OAK STREET, KISSIMMEE, FL 34744(407) 343-1278(888) 498-3604 Get Directions Write a Review

NPPES record last updated: January 24, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 24, 2023, May 12, 2022 (2 updates tracked since 2022).

About Ebenezer Medical Center Orlando Corp. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EBENEZER MEDICAL CENTER ORLANDO CORP. (NPI 1265178131) is a healthcare organization registered as a general practice in Kissimmee, Florida and active in the NPI registry since May 2022. The organization holds a CLIA Waiver certificate valid through January 23, 2027 and lists Maite Jimenez, Owner, as its authorized official.

NPPES Registry Identity

NPI1265178131
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameEBENEZER MEDICAL CENTER ORLANDO CORP.
Location Address845 E OAK STREETKissimmee, FL 34744-5838
Mailing Address845 E Oak StreetKissimmee, FL 34744-5838 · (407) 343-1278 · Fax (888) 498-3604
Phone(407) 343-1278
Fax(888) 498-3604
Organization SubpartNo
Authorized OfficialMaite JimenezOwner · (305) 491-3969
Enumeration DateMay 12, 2022
Last NPPES UpdateJanuary 24, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 18, 2023
✔ NPI 1265178131 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
845 E OAK STREET, Kissimmee, FL 34744
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ebenezer Medical Center Orlando Corp. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Ebenezer Medical Center Orlando Corp., which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (3)

Janice Ramos Colon, MD
General Practice
NPI 1194999813
6336 W COLONIAL DR
Orlando, FL 32818
(407) 259-2383
✔ PECOS✔ Accepts Medicare18 mi
Souheil Moussly, MD
Internal Medicine
NPI 1063524577
3890 TURTLE CREEK DR
Port Orange, FL 32129
(386) 756-4400
✔ PECOS61 mi
Daniel Herrera Infante, APRN
Nurse Practitioner
NPI 1316416340
1475 W 49TH PL
Hialeah, FL 33012
(305) 558-2500
✔ PECOS✔ Accepts Medicare180 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2275504

Ebenezer Medical Center Orlando Corp · Kissimmee, FL
Active · expires Jan 23, 2027
CLIA Number10D2275504
Laboratory TypePhysician Office
Certificate Effective DateJanuary 24, 2025
Certificate Expiration DateJanuary 23, 2027
Laboratory DirectorSouheil Moussly
Laboratory Phone(407) 343-1278
Laboratory LocationEbenezer Medical Center Orlando Corp845 E Oak Street, Kissimmee, FL 34744
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebenezer Medical Center Orlando Corp.'s NPI number?

The NPI number for Ebenezer Medical Center Orlando Corp. is 1265178131. It was assigned to this organization in the NPPES registry on May 12, 2022.

Where is Ebenezer Medical Center Orlando Corp. located?

Ebenezer Medical Center Orlando Corp. is located at 845 E Oak Street, Kissimmee, FL 34744. The listed phone number is (407) 343-1278.

What is Ebenezer Medical Center Orlando Corp.'s specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Ebenezer Medical Center Orlando Corp. enrolled in Medicare?

Yes. Ebenezer Medical Center Orlando Corp. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Ebenezer Medical Center Orlando Corp.?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Ebenezer Medical Center Orlando Corp., in General Practice, Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Ebenezer Medical Center Orlando Corp. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2275504) is associated with this NPI, valid through January 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ebenezer Medical Center Orlando Corp. was last updated on January 24, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.