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VIDALTIA CORP.
NPI 1336008036
Internal Medicine in Fort Lauderdale, FL

Active since January 19, 2026
6456 NW 5TH WAY, FORT LAUDERDALE, FL 33309(202) 802-0082 Get Directions Write a Review

NPPES record last updated: May 26, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 26, 2026, Jan 19, 2026 (2 updates tracked since 2026).

About Vidaltia Corp. NPPES

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

VIDALTIA CORP. (NPI 1336008036), doing business as Vidaltia, is a healthcare organization registered as an internal medicine in Fort Lauderdale, Florida and active in the NPI registry since January 2026. The organization lists Ezechiel Fenelon, Ceo, as its authorized official.

NPPES Registry Identity

NPI1336008036
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameVIDALTIA CORP.
Location Address6456 NW 5TH WAYFort Lauderdale, FL 33309-6112
Mailing Address6456 Nw 5th WayFort Lauderdale, FL 33309-6112 · (202) 802-0082
Phone(202) 802-0082
Organization SubpartNo
Authorized OfficialEzechiel FenelonCeo · (202) 802-0082
Enumeration DateJanuary 19, 2026
Last NPPES UpdateMay 26, 20262 updates tracked since enumeration
NPPES CertifiedMay 26, 2026
✔ NPI 1336008036 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedClinic/Center · Federally Qualified Health Center (FQHC)Taxonomy 261QF0400X
Also ListedClinic/Center · Health ServiceTaxonomy 261QH0100X
Also ListedClinic/Center · Infusion TherapyTaxonomy 261QI0500X
Also ListedClinic/Center · Public Health, FederalTaxonomy 261QP0904X
Also ListedClinic/Center · Public Health, State or LocalTaxonomy 261QP0905X
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X
Also ListedClinic/Center · PainTaxonomy 261QP3300X
Also ListedClinic/Center · VATaxonomy 261QV0200X
Also ListedClinic/Center · Occupational MedicineTaxonomy 261QX0100X
Also ListedChronic Disease HospitalTaxonomy 281P00000X
Also ListedExclusive Provider OrganizationTaxonomy 302F00000X
Also ListedHealth Maintenance OrganizationTaxonomy 302R00000X
Also ListedPreferred Provider OrganizationTaxonomy 305R00000X
Also ListedPoint of ServiceTaxonomy 305S00000X
6456 NW 5TH WAY, Fort Lauderdale, FL 33309
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Other Names 1

Doing Business AsVidaltia

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Vidaltia Corp. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Vidaltia Corp., which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Serena Bebe, APRN, FNP-BC
Nurse Practitioner
NPI 1598341778
2901 CORAL HILLS DR STE 330
Coral Springs, FL 33065
(954) 231-8700
✔ PECOS7.6 mi
Omari Ruffin, M.D.
Emergency Medicine
NPI 1235320052
2799 W GRAND BLVD
Detroit, MI 48202
(313) 916-2600
✔ PECOS✔ Accepts Medicare1,126 mi

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

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 Vidaltia Corp.'s NPI number?

The NPI number for Vidaltia Corp. is 1336008036. It was assigned to this organization in the NPPES registry on January 19, 2026. The provider is doing business as Vidaltia.

Where is Vidaltia Corp. located?

Vidaltia Corp. is located at 6456 NW 5th Way, Fort Lauderdale, FL 33309. The listed phone number is (202) 802-0082.

What is Vidaltia Corp.'s specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Vidaltia Corp. enrolled in Medicare?

Yes. Vidaltia Corp. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Vidaltia Corp.?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Vidaltia Corp., in Emergency 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. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Vidaltia Corp. was last updated on May 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.