Individual provider Active NPI

Roma Patel, DPM

  • Podiatrist
  • Winter Garden, FL
National Provider Identifier
1174078109
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO3710 Issued in FL
Practice address
15815 Shaddock Dr Ste 130
Winter Garden, FL 34787-5773
Phone
(407) 605-2321
Fax
(407) 671-4155
NPI assigned
Aug 19, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Public Medicine Podiatrist 213EP0504X PO3710 FL
Primary Podiatric Medicine Podiatrist 213EP1101X PO3710 FL
Foot & Ankle Surgery Podiatrist 213ES0103X PO3710 FL
Foot Surgery Podiatrist 213ES0131X PO3710 FL
Podiatrist 213E00000X PO3710 FL Primary

Addresses

Primary practice location

15815 Shaddock Dr Ste 130
Winter Garden, FL 34787-5773

Mailing address

15815 Shaddock Dr Ste 130
Winter Garden, FL 34787-5773
Phone (813) 400-1140

Other identifiers 3

IdentifierTypeStateIssuer
020299700MedicaidFL
13880016OtherCAQH ID
IY9YJOtherFLBCBS

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170104001448 FL Practitioner - Podiatry 6305135278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
All Podiatry Group Inc.Group PAC ID 0042252140, 42 clinicians

Practice addresses (Care Compare)

15815 Shaddock Dr
Suite 130
Winter Garden, FL 34787-5773
Phone (407) 605-2321

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue14
Removal of nail tissue521
Removal or shaving of skin growth481

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PO3710FLMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
All Podiatry Group Inc Podiatrist CurrentSince Jan 1, 2021 Accepting new patients
Anne McNamara DPM PL Podiatrist PastSince Jan 29, 2023 Accepting new patients
Advanced Foot & Ankle Podiatrist Past Accepting new patients

Locations

540 Medical Oaks Ave
Ste 101
Brandon, FL 33511
Phone (813) 681-3558

178 Wilshire Blvd
Casselberry, FL 32707
Phone (407) 331-4115

2511 W Mlk Blvd
Tampa, FL 33607
Phone (813) 400-1140

15815 Shaddock Dr
Ste 130
Winter Garden, FL 34787
Phone (407) 605-2321

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1471564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1174078109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15815 SHADDOCK DR STE 130",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347875773",
            "telephone_number": "813-400-1140",
            "fax_number": "813-701-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15815 SHADDOCK DR STE 130",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347875773",
            "telephone_number": "407-605-2321",
            "fax_number": "407-671-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "ROMA",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-19",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213EP0504X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Public Medicine",
            "state": "FL",
            "license": "PO3710",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "FL",
            "license": "PO3710",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3710",
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "FL",
            "license": "PO3710",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO3710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020299700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID",
            "identifier": "13880016",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "IY9YJ",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Garden, FL

Sources for this page

Verify at the official NPI Registry.