Individual provider Active NPI

Randolph Mendoza Nunag

  • Internal Medicine Physician
  • Weeki Wachee, FL
National Provider Identifier
1417950148
Registry record updated Mar 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME89446 Issued in FL
Practice address
10222 Yale Ave
Weeki Wachee, FL 34613-8375
Phone
(352) 597-9797
Fax
(352) 597-5556
NPI assigned
May 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2014

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 ME89446 FL Primary

Addresses

Primary practice location

10222 Yale Ave
Weeki Wachee, FL 34613-8375

Mailing address

10222 Yale Ave
Weeki Wachee, FL 34613-8375
Phone (352) 597-9797

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
I20040803000029 FL Practitioner - Internal Medicine 9638140841 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clemente P Nunag MD PAGroup PAC ID 5991792723, 2 clinicians

Practice addresses (Care Compare)

10222 Yale Ave
Weeki Wachee, FL 34613-8375
Phone (352) 597-9797

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa General Hospital Current Accepting new patients
Clemente P Nunag MD PA Internal Medicine CurrentSince Jul 15, 2004 Accepting new patients

Locations

10222 Yale Ave
Weeki Wachee, FL 34613
Phone (352) 597-9797

Interoperability endpoints

  • Direct secure messaging: rnunag296199@direct.tgh.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 2

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 2

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": "1117065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393891200000",
    "number": "1417950148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10222 YALE AVE",
            "city": "WEEKI WACHEE",
            "state": "FL",
            "postal_code": "346138375",
            "telephone_number": "352-597-9797",
            "fax_number": "352-597-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10222 YALE AVE",
            "city": "WEEKI WACHEE",
            "state": "FL",
            "postal_code": "346138375",
            "telephone_number": "352-597-9797",
            "fax_number": "352-597-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUNAG",
        "first_name": "RANDOLPH",
        "middle_name": "MENDOZA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-26",
        "last_updated": "2014-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME89446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weeki Wachee, FL

Sources for this page

Verify at the official NPI Registry.