Individual provider Active NPI

Gladys Perez, M.D.

  • Family Medicine Physician
  • Port Charlotte, FL
National Provider Identifier
1245225895
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME58745 Issued in FL
Practice address
2315 Aaron St
Port Charlotte, FL 33952-5305
Phone
(941) 979-5700
Fax
(941) 613-1387
NPI assigned
Sep 20, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

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 ME58745 FL Primary

Addresses

Primary practice location

2315 Aaron St
Port Charlotte, FL 33952-5305

Mailing address

19531 Cochran Blvd
Port Charlotte, FL 33948-2081
Phone (941) 255-3535

Other identifiers 1

IdentifierTypeStateIssuer
11559OtherFLBLUE CROSS AND BLUE SHIEL

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
I20040719001261 FL Practitioner - Internal Medicine 2264411503 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Wisconsin, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

19531 Cochran Blvd
Port Charlotte, FL 33948-2081
Phone (941) 255-3535

21298 Olean Blvd
Port Charlotte, FL 33952-6705
Phone (941) 629-1181

6101 Pine Ridge Rd
Naples, FL 34119-3900
Phone (239) 649-3312

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME58748FLMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC Family Medicine CurrentSince Oct 1, 2010 Accepting new patients
Millennium Physician Group LLC Family Medicine CurrentSince Oct 1, 2010 Accepting new patients
National Medical Affiliates Inc Past Accepting new patients

Locations

350 7th St N
Naples, FL 34102
Phone (239) 436-5000

8300 Collier Blvd
Naples, FL 34114
Phone (239) 354-6000

3434 Hancock Bridge Pkwy
North Ft Myers, FL 33903

2351 Aaron St
Port Charlotte, FL 33952
Phone (855) 674-7500

2315 Aaron St
Port Charlotte, FL 33952
Phone (941) 613-2222

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

2343 Aaron St
Pt Charlotte, FL 33952
Phone (855) 979-5700

809 E Marion Ave
Punta Gorda, FL 33950
Phone (941) 625-1951

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.

Hospital & facility affiliations 3

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1245225895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19531 COCHRAN BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339482081",
            "telephone_number": "941-255-3535",
            "fax_number": "941-743-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 AARON ST",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525305",
            "telephone_number": "941-979-5700",
            "fax_number": "941-613-1387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "GLADYS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-20",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME58745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "11559",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.