Individual provider Active NPI

Ildefonso Gomez, M.D.

  • Internal Medicine Physician
  • Tamarac, FL
National Provider Identifier
1295797645
Registry record updated Mar 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME 90272 Issued in FL
Practice address
7101 W McNab Rd Ste 101
Tamarac, FL 33321-5351
Phone
(954) 722-5600
Fax
(855) 252-2845
NPI assigned
Apr 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME 90272 FL Primary

Addresses

Primary practice location

7101 W McNab Rd Ste 101
Tamarac, FL 33321-5351

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ildefonso.gomez.1@29601.direct.athenahealth.com Direct

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
I20050902000008 FL Practitioner - Internal Medicine 4587696299 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conviva Medical Center Management, LLCGroup PAC ID 4284717422, 507 clinicians

Practice addresses (Care Compare)

7101 W McNab Rd
Suite 101
Tamarac, FL 33321-5351
Phone (954) 722-5600

Hospital & facility affiliations

  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 90272FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Conviva Medical Center Management LLC Internal Medicine CurrentSince Aug 1, 2020 Accepting new patients

Locations

6221 N Federal Hwy
Ft Lauderdale, FL 33308
Phone (954) 491-1686

3100 Stirling Rd
#A
Hollywood, FL 33021
Phone (954) 962-9811

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

4960 SW 72nd Ave
Ste 406
Miami, FL 33155

228 W Alexander St
Plant City, FL 33563
Phone (813) 754-5480

7101 W McNab Rd
Ste 101
Tamarac, FL 33321
Phone (954) 722-5600

Organizations & group practices 1

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 4

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": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772496000000",
    "number": "1295797645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000",
            "fax_number": "305-500-2145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 W MCNAB RD STE 101",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333215351",
            "telephone_number": "954-722-5600",
            "fax_number": "855-252-2845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "ILDEFONSO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-03",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 90272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ildefonso.gomez.1@29601.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7101 W McNab Rd Ste 101",
            "city": "Tamarac",
            "state": "FL",
            "country_code": "US",
            "postal_code": "333215351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tamarac, FL

Sources for this page

Verify at the official NPI Registry.