Individual provider Active NPI

Rene S Vasquez, M.D.

  • Family Medicine Physician
  • Deland, FL
National Provider Identifier
1245391986
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
100810 Issued in FL
Practice address
929 N Spring Garden Ave Ste 170
Deland, FL 32720-0917
Phone
(386) 738-9144
Fax
(877) 245-1597
NPI assigned
Dec 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 100810 FL Primary

Addresses

Primary practice location

929 N Spring Garden Ave Ste 170
Deland, FL 32720-0917

Mailing address

6101 Blue Lagoon Dr Ste 400
Miami, FL 33126-2051
Phone (305) 500-2000

Other identifiers 1

IdentifierTypeStateIssuer
036052042MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rene.vasquez@conviva.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070123000059 IL Practitioner - Family PracticePractitioner - General PracticePractitioner - Geriatric Medicine 9931100765 Reassigns benefits to 1 organization
I20171118000181 FL Practitioner - General Practice 9931100765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1969
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6101 Blue Lagoon Dr
Suite 400
Miami, FL 33126

6101 Blue Lagoon Dr
Suite 400
Miami, FL 33126-2051

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
100810FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health & Hospitals Corporation CurrentSince Feb 10, 2014 Accepting new patients
Conviva Medical Center Management LLC Family Medicine CurrentSince Jan 1, 2021 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Feb 10, 2014 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Metcare of Florida, Inc Past Accepting new patients
Rene S Vasquez M D S C Family Medicine PastSince Feb 1, 2007 Accepting new patients

Locations

731 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 257-1626

929 N Spring Garden Ave
Ste 170
Deland, FL 32720
Phone (386) 738-3896

5238 Norwood Ave
#16
Jacksonville, FL 32208
Phone (904) 265-2050

4960 SW 72nd Ave
Ste 406
Miami, FL 33155

6101 Blue Lagoon Dr
Ste 400
Miami, FL 33126
Phone (305) 500-2114

6101 Waterford District Dr
Ste 200
Miami, FL 33126
Phone (407) 533-6836

595 William R Latham SR Dr
Bourbonnais, IL 60914
Phone (815) 932-8944

135 N Arlington Heights Rd
Buffalo Grove, IL 60089
Phone (847) 215-8866

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

4025 N Western Ave
Chicago, IL 60618
Phone (773) 275-7700

6000 W Touhy Ave
Chicago, IL 60646
Phone (708) 390-5928

29373 Network Pl
Chicago, IL 60673

Interoperability endpoints

  • Direct secure messaging: rene.vasquez@conviva.eclinicaldirectplus.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1245391986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 400",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331262051",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 N SPRING GARDEN AVE STE 170",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327200917",
            "telephone_number": "386-738-9144",
            "fax_number": "877-245-1597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "RENE",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2022-07-21",
        "certification_date": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "100810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036052042",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rene.vasquez@conviva.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "929 N Spring Garden Ave Ste 170",
            "city": "Deland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327200917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Deland, FL

Sources for this page

Verify at the official NPI Registry.