Cesar Duque Gomez, MD
Individual provider Active NPI Family Medicine Physician · San Ysidro, CA
NPI 1154513877 · NPPES record last updated Aug 1, 2023
Key facts
- NPI
- 1154513877
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- A100269 (CA)
- Practice address
- 4004 Beyer Blvd
San Ysidro, CA 92173-2007 - Phone
- (619) 662-4100
- Fax
- (619) 428-7952
- NPI assigned
- Aug 16, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Wisconsin School of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
15 Grumman Rd W
Bethpage, NY 11714-5029
PO Box
Los Angeles, CA 90084
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220512002906 | FL | Practitioner - Family Practice | 5092902734 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A100269 | CA | MD | Family Medicine Physician |
| 100269 | CA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Prsca Medical Group PC | Family Medicine | Past | Accepting new patients |
| Emerald Medical Practice PC | Past | Accepting new patients | |
| Samg Inc | Past | Accepting new patients |
Interoperability endpoints
- cesar.gomez.1@30093.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A100269 | CA | Yes |
| Family Medicine Physician | 207Q00000X | ME138488 | FL |
Addresses
Primary practice location
4004 Beyer Blvd
San Ysidro, CA 92173-2007
Mailing address
823 Gateway Ctr. Way
San Diego, CA 92102-4541
Phone (619) 515-2300
Other practice location 1
10880 Wilshire Blvd Ste 1101
Los Angeles, CA 90024-4112
Phone (310) 295-0242
Other practice location 2
515 E Park Ave Fl 2
Tallahassee, FL 32301-2524
Phone (310) 295-0242
Other providers in San Ysidro, CA
- Dental Administratve Services
- Briana Diggins
- Fernando Alfonso Dominguez
- Jay Downey
- Susan Darsann Driscoll
- Mario M. Durazo
- Liam M Ecker
- Jennifer Estrada
- Chitra Fernando
- Cinthia Nathalie Figueroa
All providers in San Ysidro, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.