Individual provider Active NPI

Marc C. Gittelman, M.D.

  • Urology Physician
  • Aventura, FL
National Provider Identifier
1174587604
Registry record updated Apr 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
ME53015 Issued in FL
Practice address
21150 Biscayne Blvd
Suite 404
Aventura, FL 33180-1226
Phone
(305) 466-9111
Fax
(305) 466-9127
NPI assigned
Apr 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME53015 FL
Urology Physician 208800000X ME53015 FL Primary

Addresses

Primary practice location

21150 Biscayne Blvd
Suite 404
Aventura, FL 33180-1226

Mailing address

2234 Colonial Blvd
Managed Care Dept
Fort Myers, FL 33907-1412
Phone (239) 931-7342

Other identifiers 8

IdentifierTypeStateIssuer
001601400MedicaidFL
05776OtherFLBCBS FL
P0003164OtherFLFLORIDA HEALTHCARE PLUS
4068398OtherFLAETNA PROVIDER #
P00721039OtherFLRR MEDICARE
QMP000004462340OtherFLMOLINA
1193060OtherFLWELLCARE
P01730303OtherFLSIMPLY HEALTHCARE

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080128000757 FL Practitioner - Urology 9638251705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Icahn School of Medicine at Mount Sinai, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesiscare USA of Florida LLCGroup PAC ID 9830082882, 172 clinicians

Practice addresses (Care Compare)

1419 SE 8TH Ter
Cape Coral, FL 33990-3213
Phone (239) 772-3202

21150 Biscayne Blvd
Suite 104
Aventura, FL 33180-1231
Phone (305) 535-2170

2801 NE 213TH St
1001 Uro Medix
Aventura, FL 33180-1265
Phone (305) 466-9111

603 N Flamingo Rd
Suite 251
Pembroke Pines, FL 33028-1013
Phone (954) 430-5200

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as individual
Promoting interoperability
97
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME53015FLMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Genesiscare USA of Florida LLC Urology CurrentSince May 14, 2014 Accepting new patients
Genesiscare USA of Florida LLC Urology CurrentSince May 14, 2014 Accepting new patients
Genesiscare USA of Florida LLC Urology Current Accepting new patients

Locations

2801 NE 213th St
Ste 1001
Aventura, FL 33180
Phone (305) 466-9111

1419 SE 8th Ter
Cape Coral, FL 33990
Phone (239) 772-3202

2160 Colonial Blvd
Fort Myers, FL 33907

2234 Colonial Blvd
Fort Myers, FL 33907
Phone (239) 931-7212

7150 W 20th Ave
Hialeah, FL 33016
Phone (305) 558-4035

7100 W 20th Ave
Ste G154
Hialeah, FL 33016
Phone (305) 558-6518

21150 Biscayne Blvd
Ste 104
Miami, FL 33180
Phone (305) 535-2170

21150 Biscayne Blvd
Ste 404
Miami, FL 33180
Phone (305) 466-9111

730 Goodlette Rd
Ste 201
Naples, FL 34102
Phone (239) 262-1119

603 N Flamingo Rd
Ste 251
Pembroke Pnes, FL 33028
Phone (954) 430-3999

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

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": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491782400000",
    "number": "1174587604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2234 COLONIAL BLVD",
            "address_2": "MANAGED CARE DEPT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071412",
            "telephone_number": "239-931-7342",
            "fax_number": "239-931-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21150 BISCAYNE BLVD",
            "address_2": "SUITE 404",
            "city": "AVENTURA",
            "state": "FL",
            "postal_code": "331801226",
            "telephone_number": "305-466-9111",
            "fax_number": "305-466-9127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GITTELMAN",
        "first_name": "MARC",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2017-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME53015",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME53015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001601400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "05776",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA HEALTHCARE PLUS",
            "identifier": "P0003164",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER #",
            "identifier": "4068398",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00721039",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "QMP000004462340",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "1193060",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIMPLY HEALTHCARE",
            "identifier": "P01730303",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aventura, FL

Sources for this page

Verify at the official NPI Registry.