NPIMap

Individual provider Active NPI

Kyle R Gormezano, M.D.

  • Diagnostic Radiology Physician
  • Jupiter, FL
National Provider Identifier
1225027592
Registry record updated Feb 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME77760 Issued in FL
Practice address
500 Peacock LN N
Jupiter, FL 33458-8333
Phone
(952) 595-1100
Fax
(612) 294-4903
NPI assigned
Oct 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036138160 IL
Diagnostic Ultrasound Physician 2085U0001X ME77760 FL
General Practice Physician 208D00000X MD455215 PA
Diagnostic Radiology Physician 2085R0202X ME77760 FL Primary

Addresses

Primary practice location

500 Peacock LN N
Jupiter, FL 33458-8333

Mailing address

500 Peacock LN N
Jupiter, FL 33458-8333
Phone (561) 512-9780

Other practice location 1

4201 W Medical Center Dr
McHenry, IL 60050-8409
Phone (815) 334-5566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240212000646 IL Practitioner - Diagnostic Radiology 7214923796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4201 W Medical Ctr Dr
McHenry, IL 60050-8409
Phone (815) 759-4323

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036138160ILMDDiagnostic Radiology Physician
ME77760FLMDDiagnostic Ultrasound Physician
MD455215PAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Feb 1, 2024 Accepting new patients
Northwestern Medical Faculty Foundation Diagnostic Radiology CurrentSince Feb 1, 2024 Accepting new patients
S Viroja PA CurrentSince Mar 29, 2023 Accepting new patients
Palms West Imaging Inc Diagnostic Radiology Past Accepting new patients
Gardens Radiology Associates, PA Diagnostic Radiology Past Accepting new patients
Palms West MRI, LLC Past Accepting new patients
Radiology Consultants PA Diagnostic Radiology Past Accepting new patients

Locations

10101 Forest Hill Blvd
West Palm Beach, FL 33414
Phone (561) 766-1301

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

4201 W Medical Center Dr
McHenry, IL 60050
Phone (815) 759-3100

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

Organizations & group practices 7

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 6

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": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708300800000",
    "number": "1225027592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PEACOCK LN N",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334588333",
            "telephone_number": "561-512-9780",
            "fax_number": "866-611-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PEACOCK LN N",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334588333",
            "telephone_number": "952-595-1100",
            "fax_number": "612-294-4903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4201 W Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "McHenry",
            "state": "IL",
            "postal_code": "600508409",
            "country_code": "US",
            "telephone_number": "815-334-5566",
            "fax_number": "815-759-4008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORMEZANO",
        "first_name": "KYLE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036138160",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "FL",
            "license": "ME77760",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PA",
            "license": "MD455215",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME77760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jupiter, FL

Sources for this page

Verify at the official NPI Registry.