NPIMap

Individual provider Active NPI

Tamara Ivelisse Guzman Rodriguez, MD

  • General Practice Physician
  • Davenport, FL
National Provider Identifier
1063443612
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN 448 Issued in FL
Practice address
130 Ridge Center Dr
Davenport, FL 33837-6413
Phone
(866) 234-8534
NPI assigned
Jul 5, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 15632 PR
General Practice Physician 208D00000X ACN 448 FL Primary

Addresses

Primary practice location

130 Ridge Center Dr
Davenport, FL 33837-6413

Mailing address

47 5TH St NW
Winter Haven, FL 33881-4672
Phone (866) 234-8534

Other identifiers 2

IdentifierTypeStateIssuer
ACN 448OtherFLLICENSE
1063443612MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060117000143 PR Practitioner - General Practice 4284658378 Reassigns benefits to 1 organization
Practice locations: Mayaguez, PR
I20220331000493 FL Practitioner - General Practice 4284658378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Florida Health Care IncGroup PAC ID 0143127951, 33 clinicians

Practice addresses (Care Compare)

1514 1St St N
Winter Haven Clinic
Winter Haven, FL 33881-2476
Phone (866) 234-8534

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15632PRMDClinical Social Worker
ACN 448FLMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bella Vista Hospital Inc CurrentSince Dec 22, 2020 Accepting new patients
Bella Vista Hospital, Inc CurrentSince Dec 22, 2020 Accepting new patients
Central Florida Health Care, Inc. CurrentSince Apr 28, 2022 Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc. General Practice Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc Past Accepting new patients
Central Florida Health Care Inc Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care Inc Past Accepting new patients
Central Florida Health Care, Inc Past Accepting new patients

Locations

109 W Wall St
Frostproof, FL 33843
Phone (863) 635-4891

705 Ingraham Ave
Haines City, FL 33844
Phone (863) 291-3314

1129 N Missouri Ave
Lakeland, FL 33805
Phone (863) 413-8600

807 Cobb Ct
Wauchula, FL 33873

1514 1st St N
Winter Haven, FL 33881
Phone (863) 291-5110

47 5th St NW
Winter Haven, FL 33881

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FAHDAD
  • Direct secure messaging: tamara.guzman.1@12125.direct.athenahealth.com

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1063443612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 5TH ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814672",
            "telephone_number": "866-234-8534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 RIDGE CENTER DR",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338376413",
            "telephone_number": "866-234-8534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUZMAN RODRIGUEZ",
        "first_name": "TAMARA",
        "middle_name": "IVELISSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2023-03-07",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "15632",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN 448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "ACN 448",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063443612",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, FL

Sources for this page

Verify at the official NPI Registry.