Widdler Deshommes, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ACN1610 Issued in FL

Practice address

4601 N Highway 19a
Mount Dora, FL 32757-2039

Phone

(352) 290-8718

NPI assigned

Apr 4, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CIEIDD/Endpoint/CIEIDD

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.

• Alina Community Center at Mount Dora LLC

  • Family Medicine Physician
  • Mount Dora, FL
  • NPI 1811550346
  Medicare reassignment NPD
• Alina Health Medical Center Corp.

  • Family Medicine Physician
  • Lauderdale Lakes, FL
  • NPI 1144975418
  Medicare reassignment NPD
• Elite Med Family Care Inc

  • Primary Care Clinic/Center
  • Kissimmee, FL
  • NPI 1164229985
  Medicare reassignment NPD
• Alina Community Center at Mount Dora LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mount Dora, FL
  • NPI 1841801842
  NPD
• Alina Health Medical Center Corp.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lauderdale Lakes, FL
  • NPI 1194459297
  NPD

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

{
    "created_epoch": "1585958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709856000000",
    "number": "1376172015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 ROUZER ST",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327123650",
            "telephone_number": "407-575-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 N HIGHWAY 19A",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327572039",
            "telephone_number": "352-290-8718"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4540 E Baseline Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852064616",
            "country_code": "US",
            "telephone_number": "480-272-8944",
            "fax_number": "480-237-5682",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "425 S Hunt Club Blvd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Apopka",
            "state": "FL",
            "postal_code": "327032428",
            "country_code": "US",
            "telephone_number": "407-304-9337",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Calle Palma",
            "address_purpose": "LOCATION",
            "city": "Arecibo",
            "state": "PR",
            "postal_code": "006124526",
            "country_code": "US",
            "telephone_number": "787-650-1030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESHOMMES",
        "first_name": "WIDDLER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-04",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "023661",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "000229-P.A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "8363",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "TPPA363",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine M Demarco
• Robert W Demetrius, MD
• Dermatology Group PA
• Marie Derozin, RBT
• Purvi Desai, DO
• Aliyyah Dewji
• Haleigh Dhaiti
• Samuel Mark Dickinson
• Sebastian Dickson
• Tiffany Lee Dickson, MSW

• General Practice Physician in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; 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.