Individual provider Active NPI

Angela Marie Blanco Guertin, DO

  • Family Medicine Physician
  • South Miami, FL
National Provider Identifier
1205417474
Registry record updated Mar 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS20129 Issued in FL
Practice address
5975 Sunset Dr Ste 402
South Miami, FL 33143-5198
Phone
(305) 669-2833
NPI assigned
Apr 19, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS20129 FL Primary

Addresses

Primary practice location

5975 Sunset Dr Ste 402
South Miami, FL 33143-5198

Mailing address

13317 Majestic Way
Cooper City, FL 33330-2656
Phone (954) 547-4853

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
I20241210001588 FL Practitioner - Emergency Medicine 8224427331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Criticare Clinics IncGroup PAC ID 7517966534, 104 clinicians

Practice addresses (Care Compare)

15885 Pines Blvd
Pembroke Pines, FL 33027-1220
Phone (954) 837-1300

Hospital & facility affiliations

  • South Miami Hospital Hospital, Miami, FL, CCN 100154

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS20129FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Criticare Clinics Inc CurrentSince Sep 28, 2024 Accepting new patients
Baptist Health Medical Group Physicians LLC PastSince Apr 1, 2021 Accepting new patients
Pedem PLLC PastSince Mar 11, 2025 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

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1618790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740873600000",
    "number": "1205417474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13317 MAJESTIC WAY",
            "city": "COOPER CITY",
            "state": "FL",
            "postal_code": "333302656",
            "telephone_number": "954-547-4853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5975 SUNSET DR STE 402",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331435198",
            "telephone_number": "305-669-2833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANCO GUERTIN",
        "first_name": "ANGELA",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-19",
        "last_updated": "2025-03-02",
        "certification_date": "2025-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS20129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Miami, FL

Sources for this page

Verify at the official NPI Registry.