Individual provider Active NPI

Samuel A. Rodriguez Burgos, M.D.

  • General Practice Physician
  • Orlando, FL
National Provider Identifier
1447386487
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN1521 Issued in FL
Practice address
6210 W Colonial Dr Ste 100
Orlando, FL 32808-7504
Phone
(407) 931-0444
Fax
(407) 652-5207
NPI assigned
Feb 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X ACN1521 FL Primary

Addresses

Primary practice location

6210 W Colonial Dr Ste 100
Orlando, FL 32808-7504

Mailing address

931 W Oak St Ste 103
Kissimmee, FL 34741-4973
Phone (407) 931-0444

Other practice location 1

931 W Oak St Ste 103
Kissimmee, FL 34741-4973
Phone (407) 931-0444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ACN1521FLMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Family Medical Inc General Practice CurrentSince Aug 27, 2023 Accepting new patients
Orlando Family Medical Inc General Practice CurrentSince Aug 27, 2023 Accepting new patients

Locations

931 W Oak St
Ste 103
Kissimmee, FL 34741
Phone (407) 922-4839

6210 W Colonial Dr
Ste 100
Orlando, FL 32808

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.

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1447386487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 W OAK ST STE 103",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414973",
            "telephone_number": "407-931-0444",
            "fax_number": "407-962-4446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6210 W COLONIAL DR STE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328087504",
            "telephone_number": "407-931-0444",
            "fax_number": "407-652-5207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "931 W Oak St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347414973",
            "country_code": "US",
            "telephone_number": "407-931-0444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ BURGOS",
        "first_name": "SAMUEL",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.