Individual provider Active NPI

Jose Emanuel Melendez Gonzalez, MD

  • Student in an Organized Health Care Education/Training Program
  • Miami, FL
National Provider Identifier
1336766302
Registry record updated Mar 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
11750 SW 40TH St
Miami, FL 33175-3530
Phone
(305) 223-3000
NPI assigned
Jun 25, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 15456-I PR
Student in an Organized Health Care Education/Training Program 390200000X PR Primary

Addresses

Primary practice location

11750 SW 40TH St
Miami, FL 33175-3530

Mailing address

Urb Medina Calle 5
Casa D-40
Isabela, PR 00662-3833
Phone (787) 454-9128

Other practice location 1

Avenida Severiano Cuevas
#18 Km. 141.1 Bo. Caimital Bajo
Aguadilla, PR 00603
Phone (787) 658-0000 ext. 1019

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
I20230620001457 FL Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 3870951122

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15456-IPRMDStudent in an Organized Health Care Education/Training Program

Interoperability endpoints

  • Direct secure messaging: jose.melendezgonzalez@hca4.eclinicaldirectplus.com

NPI Registry JSON

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

{
    "created_epoch": "1593043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679184000000",
    "number": "1336766302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "URB MEDINA CALLE 5",
            "address_2": "CASA D-40",
            "city": "ISABELA",
            "state": "PR",
            "postal_code": "006623833",
            "telephone_number": "787-454-9128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11750 SW 40TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331753530",
            "telephone_number": "305-223-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Avenida Severiano Cuevas",
            "address_2": "#18 Km. 141.1 Bo. Caimital Bajo",
            "address_purpose": "LOCATION",
            "city": "Aguadilla",
            "state": "PR",
            "postal_code": "00603",
            "country_code": "US",
            "telephone_number": "787-658-0000 x1019",
            "fax_number": "787-819-0805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MELENDEZ GONZALEZ",
        "first_name": "JOSE",
        "middle_name": "EMANUEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-25",
        "last_updated": "2023-03-19",
        "certification_date": "2023-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PR",
            "license": "15456-I",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.