DR. MARC A RAFOLS MD
NPI 1366893976
Surgery in Miami Beach, FL

Q: What is Marc Rafols's NPI number?

The NPI number for Marc Rafols is 1366893976. It was assigned to this individual provider in the NPPES registry on June 24, 2016.

Q: What is Marc Rafols's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Q: When was this NPI record last updated?

The NPPES record for Marc Rafols was last updated on June 16, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.

Active since June 24, 2016PECOS EnrolledAccepts Medicare Assignment

97.58/100

CMS Quality Rating

4300 ALTON RD, MIAMI BEACH, FL 33140(786) 239-1572 Get Directions Write a Review

NPPES record last updated: June 16, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 16, 2021, Jun 24, 2016 (2 updates tracked since 2016).

On this page

About Dr. Marc A Rafols Md NPPES

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

DR. MARC A RAFOLS MD (NPI 1366893976) is an individual surgery provider in Miami Beach, Florida, licensed in Florida (150479) and active in the NPI registry since June 2016. He is enrolled in Medicare PECOS, is affiliated with Mount Sinai Medical Center Of Florida, Inc, and is a graduate of Other (2016).

NPPES Registry Identity

NPI1366893976

Entity TypeIndividualMale

Primary Taxonomy208600000X

Provider Legal NameDR. MARC A RAFOLSCredential: MD

Location Address4300 ALTON RDMiami Beach, FL 33140-2948

Mailing Address4300 Alton RoadMiami Beach, FL 33140 · (786) 239-1572

Phone(786) 239-1572

Sole ProprietorNo

Medical School CMSOtherGraduated 2016

Enumeration DateJune 24, 2016

Last NPPES UpdateJune 16, 20212 updates tracked since enumeration

NPPES CertifiedJune 16, 2021

✔ NPI 1366893976 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

License✔ Licensed in FL · 150479

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

4300 ALTON RD, Miami Beach, FL 33140

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Marc A Rafols Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1254732746

PECOS Enrollment IDI20210622000181

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231

Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.

145 services60 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

45 services25 patients

Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 99221

Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.

29 services29 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

16 services16 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

14 services14 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

13 services13 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Mount Sinai Medical Center Of Florida, Inc

Acute Care Hospitals · Miami Beach, FL

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number100034

Location4300 Alton RdMiami Beach, FL 33140 · Miami-Dade County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33140 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$96.13 typical visit price

range $60.92 – $187.05

Typical copayment $24.03 (range $15.23 – $46.76)

Most-billed visit code 99203

Established Patient

$75.86 typical visit price

range $18.99 – $150.24

Typical copayment $18.96 (range $4.74 – $37.56)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

97.58/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored through an Alternative Payment Model

Quality

86.53

Promoting Interoperability

100

Improvement Activities

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBERT SCORDATO JR. PA

Physician Assistant (Medical)

4300 ALTON RD, SUITE 2070
MIAMI BEACH, FL 33140

Miami-Dade County (305) 674-2609

JESSICA EMILIA WAHI

Surgery

4300 ALTON RD
MIAMI BEACH, FL 33140

Miami-Dade County (304) 545-3095

JEAN CARLOS CORREA PHARMACIST

Pharmacist

4300 ALTON RD
MIAMI BEACH, FL 33140

Miami-Dade County (305) 674-2121

AM RYWLIN MD AND ASSOC PA

Pathology (Anatomic Pathology & Clinical Pathology)

4300 ALTON RD
MIAMI BEACH, FL 33140

Miami-Dade County (305) 674-2277

FREDERICK EMERSON HASTY IV

Anesthesiology

4300 ALTON RD, SUITE 1401
MIAMI BEACH, FL 33140

Miami-Dade County (305) 674-2742

DR. JUSTIN DANA BURKHOLDER D.O.

Emergency Medicine

4300 ALTON RD
MIAMI BEACH, FL 33140

Miami-Dade County (610) 246-8011

DR. ELIAS ATRI MD

Student in an Organized Health Care Education/Training Program

4300 ALTON RD
MIAMI BEACH, FL 33140

Miami-Dade County (305) 674-2273

ALEXIS CAMARGO DO

Student in an Organized Health Care Education/Training Program

4300 ALTON RD
MIAMI BEACH, FL 33140

Miami-Dade County (305) 674-2273

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 Marc Rafols's NPI number?

The NPI number for Marc Rafols is 1366893976. It was assigned to this individual provider in the NPPES registry on June 24, 2016.

Where is Marc Rafols located?

Marc Rafols practices at 4300 Alton Rd, Miami Beach, FL 33140. The listed phone number is (786) 239-1572.

What is Marc Rafols's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Marc Rafols enrolled in Medicare?

Yes. Marc Rafols is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Marc Rafols accept?

Health plans from Ambetter Health, Ambetter from Superior HealthPlan, Ambetter of Alabama, AvMed and Florida Blue (BlueCross BlueShield FL) and 2 other insurers list Marc Rafols as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Marc Rafols affiliated with any hospitals?

According to CMS data, Marc Rafols is affiliated with Mount Sinai Medical Center Of Florida, Inc.

When was this NPI record last updated?

The NPPES record for Marc Rafols was last updated on June 16, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.