Golden Age Physician Specialists LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GOLDEN AGE PHYSICIAN SPECIALISTS LLC

Practice address

6405 W Gulf to Lake Hwy
Crystal River, FL 34429-9354

Phone

(352) 684-8736

NPI assigned

Mar 28, 2023

Organization subpart

No

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

Authorized official

Name

Dacelin St. Martin, MD

Title

Provider

Phone

(352) 684-8736

Specialties & licenses 3

Addresses

Other names 1

• GAPS Other name

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1104520717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2066",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344602066",
            "telephone_number": "352-684-8736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6405 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344299354",
            "telephone_number": "352-684-8736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN AGE PHYSICIAN SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "ST. MARTIN",
        "authorized_official_first_name": "DACELIN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "352-684-8736",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GAPS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jenna Garrick
• William Richard Gelinas, DO
• Geoffrey Roberts, D.O.,P.a.
• George H Kaplan OD PA
• Robert Carl Goethe, MD
• Anirudh Gone, MD
• Ghislain Gonsette, PHYSICAL THERAPIST
• Jean Gonsette, PHYSICAL THERAPIST
• Jennifer Joy Gonsman, LMT
• Kady Rae Gonzalez, PHARM D

• All providers in Crystal River, FL
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.