Michael J Gomez, MD, PA
Individual provider Active NPI Pediatric Adolescent Medicine Physician · Village of Palmetto Bay, FL
NPI 1194843722 · NPPES record last updated Mar 24, 2009
Key facts
- NPI
- 1194843722
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Adolescent Medicine Physician 2080A0000X
- License
- ME94251 (FL)
- Practice address
- 8925 SW 148TH St Ste 110
Village of Palmetto Bay, FL 33176-8000 - Phone
- (786) 573-4470
- Fax
- (305) 969-1699
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
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 |
|---|---|---|---|---|
| I20121108000237 | FL | Practitioner - Pediatric Medicine |
2567613102 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Criticare Clinics Inc | Clinic/Center | Current |
Accepting new patients |
| Michael J Gomez MD PA | Past | Accepting new patients |
Locations
4741 S University Dr
Davie, FL 33328
Phone (954) 837-1050
14701 NW 77th Ave
Miami Lakes, FL 33014
Phone (305) 669-2833
15885 Pines Blvd
Pembroke Pines, FL 33027
Phone (954) 837-1300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | ME94251 | FL | |
| Pediatric Adolescent Medicine Physician | 2080A0000X | ME94251 | FL | Yes |
Addresses
Primary practice location
8925 SW 148TH St Ste 110
Village of Palmetto Bay, FL 33176-8000
Mailing address
5815 SW 45 Terrace
Miami, FL 33155
Phone (305) 742-7767
Other providers in Village of Palmetto Bay, FL
- Kenneth Flicker
- Florida Health Care Systems Inc. of Miami
- Claudia Fritz
- Lisa Galvez
- Norman Goldberg
- Jose Armando Gonzalez
- Jeanne Chatham Gottlieb
- Karl Walter Green
- Patrice Greenwald
- Mitchell Gregg
All providers in Village of Palmetto Bay, FL · Pediatric Adolescent Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2009. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.