Lisa Gonsalves, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME0060521 Issued in FL

Practice address

335 Clyde Morris Blvd
Suite 240
Ormond Beach, FL 32174-3181

Phone

(386) 231-3561

Fax

(386) 677-6501

NPI assigned

Jan 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Adventhealth Primary Care Network Inc

  • Family Medicine Physician
  • Altamonte Springs, FL
  • NPI 1093493637

  Family Medicine

  NPD

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340236800000",
    "number": "1114997616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 730729",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321730729",
            "telephone_number": "386-231-3561",
            "fax_number": "386-677-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 CLYDE MORRIS BLVD",
            "address_2": "SUITE 240",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321743181",
            "telephone_number": "386-231-3561",
            "fax_number": "386-677-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONSALVES",
        "first_name": "LISA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2012-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0060521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372053500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trista Goetz, OT
• Golden Abbey Enterprises, Inc
• Bonnie S Goldman
• Parker Goldstein, DMD
• Luis Gomez, ARNP
• Maria Gontcharova, MD
• Evelyn Gonzalez, PTA
• Laura Lyann Gonzalez, ARNP
• Lisset Gonzalez, DDS
• Sarah Elizabeth Goodman, ARNP

• All providers in Ormond Beach, FL
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.