Maria Gavancho Sotomayor, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME94010 Issued in FL

Practice address

3622 Madaca LN
Tampa, FL 33618-2057

Phone

(813) 513-3643

Fax

(813) 605-5465

NPI assigned

Feb 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Dermatology

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Palm Harbor Dermatology PAGroup PAC ID 4789758558, 33 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: msotomayor@dmp.emadirect.md

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.

• Palm Harbor Dermatology PA

  • Dermatology Physician
  • Palm Harbor, FL
  • NPI 1497927016
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1316912082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4919 MEMORIAL HWY STE 150",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336347516",
            "telephone_number": "813-333-1512",
            "fax_number": "813-333-1561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3622 MADACA LN",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336182057",
            "telephone_number": "813-513-3643",
            "fax_number": "813-605-5465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOTOMAYOR",
        "first_name": "MARIA",
        "middle_name": "GAVANCHO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME94010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110175900",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msotomayor@dmp.emadirect.md",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3622 Madaca Ln",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336182057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Aliana Sotolongo, BCBA
• Luisa Katerine Sotomayor Chacon
• Eduardo M Sotomayor, MD
• Jorge Alberto Sotomayor
• Jorge Luis Sotomayor, MA
• Kathy C Souder, LMT
• Solangie Souffront
• Maral Soufleris, NP
• Mohamad Rudwan Soukieh, DO
• Soul Purpose Counseling and Consulting PLLC

• Dermatology Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; 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.
• Medicare Care Compare (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.