Organization Active NPI

Caceres Specialized Gynecology, LLC

  • Gynecology Physician
  • Kissimmee, FL
National Provider Identifier
1073069159
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
ME98869 Issued in FL
Legal business name
CACERES SPECIALIZED GYNECOLOGY, LLC
Practice address
1136 Cypress Glen Cir
Kissimmee, FL 34741-7559
Phone
(407) 392-2777
Fax
(407) 605-5999
NPI assigned
Aug 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Authorized official

Name
Dr. Aileen Caceres, MDNPI 1295829919
Title
President/Owner
Phone
(321) 286-6222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207VG0400X ME98869 FL Primary

Addresses

Primary practice location

1136 Cypress Glen Cir
Kissimmee, FL 34741-7559

Mailing address

15502 Stoneybrook West Pkwy
Suite 104-241
Winter Garden, FL 34787-4767
Phone (321) 286-6222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161107001045 FL Part B Supplier - Clinic/Group Practice 4082992466 Receives reassigned benefits from 1 practitioner
Practice locations: Kissimmee, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2133463Caceres Specialized Gynecology1136 Cypress Glen Circle, Kissimmee, FL 34741Certificate of waiverJul 12, 2027

National Provider Directory

National Provider Directory

Locations

1136 Cypress Glen Cir
Kissimmee, FL 34741
Phone (321) 286-6222

15502 Stoneybrook West Pkwy
Ste 104241
Winter Garden, FL 34787

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744848000000",
    "number": "1073069159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15502 STONEYBROOK WEST PKWY",
            "address_2": "SUITE 104-241",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347874767",
            "telephone_number": "321-286-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 CYPRESS GLEN CIR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347417559",
            "telephone_number": "407-392-2777",
            "fax_number": "407-605-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CACERES SPECIALIZED GYNECOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-29",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A",
        "authorized_official_last_name": "CACERES",
        "authorized_official_first_name": "AILEEN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "321-286-6222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "FL",
            "license": "ME98869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.