NPIMap

Individual provider Active NPI

Gerardo Gomez Cordoba, MD

  • General Practice Physician
  • Tampa, FL
National Provider Identifier
1013014281
Registry record updated May 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN775 Issued in FL
Practice address
205 W Busch Blvd
Tampa, FL 33612-7900
Phone
(813) 514-2333
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X ACN775 FL Primary
General Practice Physician 208D00000X 12396 PR

Addresses

Primary practice location

205 W Busch Blvd
Tampa, FL 33612-7900

Mailing address

12171 SW 268TH St
Homestead, FL 33032-8001
Phone (813) 514-2333

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
I20160524000333 FL Practitioner - General Practice 6305928060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suncoast Community Health Centers Inc 30 clinicians

Practice addresses (Care Compare)

14254 Martin Luther King Blvd
Dover, FL 33527-4414
Phone (813) 653-6100

14254 Sr
Dover, FL 33527-4414
Phone (813) 653-6100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ACN775FLMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Suncoast Community Health Centers, Inc CurrentSince Sep 4, 2020 Accepting new patients
Suncoast Community Health Centers Inc CurrentSince Sep 4, 2020 Accepting new patients
Suncoast Community Health Centers Inc Past Accepting new patients
Municipio de Jayuya Past Accepting new patients

Locations

313 S Lakewood Dr
Brandon, FL 33511
Phone (813) 349-7900

13110 Elk Mountain Dr
Riverview, FL 33579
Phone (813) 349-7567

2814 14th Ave SE
Ruskin, FL 33570
Phone (813) 349-7800

16621 Lagoon Shore Blvd
Wimauma, FL 33598
Phone (813) 307-3321

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557187200000",
    "number": "1013014281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12171 SW 268TH ST",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330328001",
            "telephone_number": "813-514-2333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W BUSCH BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336127900",
            "telephone_number": "813-514-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ CORDOBA",
        "first_name": "GERARDO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2019-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN775",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "12396",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.