Heidi Gamboa, D.O.

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

OS15951 Issued in FL

Practice address

3100 SW 62ND Ave
Miami, FL 33155

Phone

(305) 666-6511

NPI assigned

Jun 14, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment NPD

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558310400000",
    "number": "1285996322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553009",
            "telephone_number": "305-666-6511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33155",
            "telephone_number": "305-666-6511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 Rockland Rd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "DE",
            "postal_code": "198033607",
            "country_code": "US",
            "telephone_number": "302-660-1584",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9000 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532264874",
            "country_code": "US",
            "telephone_number": "414-266-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAMBOA",
        "first_name": "HEIDI",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-14",
        "last_updated": "2019-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "DE",
            "license": "C7-0005845",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "WI",
            "license": "70100",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "FL",
            "license": "OS15951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285996322",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hhagerott@mcw.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9000 W Wisconsin Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532264874",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hhagerott@mcw.edu",
            "affiliation": "N",
            "endpointDescription": "hhagerott@mcw.edu",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "9000 W Wisconsin Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532264874",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hhagerott@mcw.edu",
            "affiliation": "N",
            "address_1": "3100 SW 62nd Ave",
            "city": "Miami",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bruce Gamble Jr.
• Lisandra Gamboa Hernandez, RBT
• Cynthia Gamboa Pena
• Amalia Gamboa Rueda
• Amely Gamboa
• Kirel Gamboa
• Lissette Gamboa, LMHC, BCBA
• Luke Aaron Gamboa, RBT
• Maria Jose Gamboa
• Marylena Gamboa

• Pediatric Gastroenterology Physician in Miami, FL
• Providers in Miami, FL by specialty
• Pediatric Gastroenterology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.