NPIMap

Organization Active NPI

Doctors at Home Tri County

  • Primary Care Clinic/Center
  • Orlando, FL
National Provider Identifier
1497168173
Registry record updated Sep 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
DOCTORS AT HOME TRI COUNTY
Practice address
11954 Narcoossee Rd Ste 2 #504
Orlando, FL 32832-6998
Phone
(800) 925-1840
Fax
(800) 521-9406
NPI assigned
Jun 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2022

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

Authorized official

Name
Rafael Gonzalez
Title
President
Phone
(407) 421-8553

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

11954 Narcoossee Rd Ste 2 #504
Orlando, FL 32832-6998

Mailing address

11954 Narcoossee Rd Ste 2 #504
Orlando, FL 32832-6998
Phone (800) 925-1840

Other identifiers 2

IdentifierTypeStateIssuer
ISUN3OtherFLBCBS
015701100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150615000303 FL Part B Supplier - Clinic/Group Practice 2567773849 Receives reassigned benefits from 14 practitioners
Practice locations: Orlando, FL

National Provider Directory

National Provider Directory

Locations

11954 Narcoossee Rd
Ste 25
Orlando, FL 32832

11954 Narcoossee Rd
#2504
Orlando, FL 32832
Phone (561) 632-4863

11954 Narcoossee Rd
Ste 250
Orlando, FL 32832

11954 Narcoossee Rd
Ste 2504
Orlando, FL 32832
Phone (800) 925-1840

1417 Hamlin Ave
Unit F
Saint Cloud, FL 34771
Phone (800) 925-1840

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663545600000",
    "number": "1497168173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11954 NARCOOSSEE RD STE 2 #504",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328326998",
            "telephone_number": "800-925-1840",
            "fax_number": "800-521-9406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11954 NARCOOSSEE RD STE 2 #504",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328326998",
            "telephone_number": "800-925-1840",
            "fax_number": "800-521-9406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS AT HOME TRI COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-10",
        "last_updated": "2022-09-19",
        "certification_date": "2022-06-16",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-421-8553"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "ISUN3",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015701100",
            "state": "FL"
        }
    ],
    "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 Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.