Gregorio S Santos MD PA – Primary Care Clinic/Center

Key facts

NPI: 1306156104
Entity type: Organization (NPI type 2)
Primary specialty: Primary Care Clinic/Center 261QP2300X
License: ME0072417 (FL)
Legal business name: GREGORIO S SANTOS MD PA
Practice address: 6125 54TH Ave N Ste B
Kenneth City, FL 33709-1830
Phone: (727) 521-9467
Fax: (727) 521-0416
NPI assigned: Oct 14, 2010
Organization subpart: No

Authorized official

Name: Gregorio S Santos, MD
Title: Owner
Phone: (727) 521-9467

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Gregorio S Santos, MD Internal Medicine Physician · Kenneth City, FL · NPI 1417060369

Medicare reassignment NPD FL

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
10D0966663	Gregorio Santos MD PA 6125 54TH Ave N, Kenneth City, FL 33709	Certificate of waiver	Oct 24, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in FL

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20121219000078	FL	Part B Supplier - Clinic/Group Practice	6507018678	Receives reassigned benefits from 1 practitioner Practice locations: Kenneth City, FL

National Provider Directory

Locations

6125 54th Ave N
Ste B
Kenneth City, FL 33709
Phone (727) 521-9467

Interoperability endpoints

FHIR API: https://fhir4.healow.com/fhir/r4/FIHGAA

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Primary Care Clinic/Center	261QP2300X	ME0072417	FL	Yes

Addresses

Primary practice location

6125 54TH Ave N Ste B
Kenneth City, FL 33709-1830

Mailing address

6125 54TH Ave N Ste B
Kenneth City, FL 33709-1830
Phone (727) 521-9467

Other providers in Kenneth City, FL

All providers in Kenneth City, FL · Primary Care Clinic/Center in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2012. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.