NPIMap

Organization Active NPI

Soma Medical Center, P. a #4

  • Pediatrics Physician
  • Lake Worth, FL
National Provider Identifier
1184920613
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME102127 Issued in FL
Legal business name
SOMA MEDICAL CENTER, P. A #4
Practice address
421 S Dixie Hwy
Lake Worth, FL 33460-4442
Phone
(561) 275-1155
Fax
(561) 275-1156
NPI assigned
Feb 1, 2011
Last updated
Dec 11, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
SOMA MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Authorized official

Name
Dr. Mercedes Gadea Lopez, MDNPI 1750693867
Title
Pediatrician
Phone
(561) 275-1155

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME102127 FL Primary

Addresses

Primary practice location

421 S Dixie Hwy
Lake Worth, FL 33460-4442

Mailing address

421 S Dixie Hwy
Lake Worth, FL 33460-4442
Phone (561) 275-1155

Other identifiers 1

IdentifierTypeStateIssuer
005584600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231114001055 FL Part B Supplier - Clinic/Group Practice 9234586157 Receives reassigned benefits from 2 practitioners
Practice locations: Wellington, FL; West Palm Beach, FL; Ocoee, FL; Lake Worth, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2021512Soma Medical Center # 4421 South Dixie Hwy, Lake Worth, FL 33460Certificate of waiverMar 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Soma Medical Center PA 48 organizations share this tax ID, including this one
Part of
Soma Medical Center PA

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

330 S Dixie Hwy
Ste 3
Lake Worth, FL 33460
Phone (561) 275-1155

10125 W Colonial Dr
Ste 205
Ocoee, FL 34761
Phone (407) 578-1241

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AWCHU1

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1296518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576022400000",
    "number": "1184920613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 S DIXIE HWY",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334604442",
            "telephone_number": "561-275-1155",
            "fax_number": "561-275-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 S DIXIE HWY",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334604442",
            "telephone_number": "561-275-1155",
            "fax_number": "561-275-1156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOMA MEDICAL CENTER, P. A #4",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOMA MEDICAL CENTER",
        "enumeration_date": "2011-02-01",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A",
        "authorized_official_last_name": "GADEA LOPEZ",
        "authorized_official_first_name": "MERCEDES",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "561-275-1155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME102127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005584600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Worth, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.