Individual provider Active NPI

Jose Manuel Pinero Peraza, M.D.

  • General Practice Physician
  • Gainesville, FL
National Provider Identifier
1457458887
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN547 Issued in FL
Practice address
224 SE 24TH St
Gainesville, FL 32641-7516
Phone
(352) 334-7910
Fax
(352) 334-7957
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 12816 PR
General Practice Physician 208D00000X ACN547 FL Primary

Addresses

Primary practice location

224 SE 24TH St
Gainesville, FL 32641-7516

Mailing address

224 SE 24TH St
Gainesville, FL 32641-7516
Phone (352) 334-7910

Other identifiers 1

IdentifierTypeStateIssuer
012593000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20091012000028 PR Practitioner - General Practice 7113063819 Practice locations: Hatillo, PR
I20160206000049 FL Practitioner - General Practice 7113063819 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Department of HealthGroup PAC ID 3072424282, 126 clinicians

Practice addresses (Care Compare)

224 SE 24TH St
Gainesville, FL 32641-7516
Phone (352) 334-7900

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ACN547FLMDGeneral Practice Physician
12816PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Department of Health CurrentSince Jan 14, 2016 Accepting new patients
Florida Department of Health CurrentSince Jan 14, 2016 Accepting new patients
Florida Clinical Practice Association Inc Past Accepting new patients
Florida Department of Health Past Accepting new patients

Locations

15530 NW US Highway 441
Ste 10010
Alachua, FL 32615
Phone (352) 462-2542

816 SW 64th Ter
Gainesville, FL 32607
Phone (352) 225-4320

224 SE 24th St
Gainesville, FL 32641
Phone (352) 334-7900

Organizations & group practices 4

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452816000000",
    "number": "1457458887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 SE 24TH ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326417516",
            "telephone_number": "352-334-7910",
            "fax_number": "352-334-7957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 SE 24TH ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326417516",
            "telephone_number": "352-334-7910",
            "fax_number": "352-334-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PINERO PERAZA",
        "first_name": "JOSE",
        "middle_name": "MANUEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "12816",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012593000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.