Individual provider Active NPI

Regilda Anne Romero, PHD

  • Clinical Child & Adolescent Psychologist
  • Gainesville, FL
National Provider Identifier
1518392828
Registry record updated Apr 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
PY9003 Issued in FL
Practice address
2121 NW 40TH Ter Ste B
Gainesville, FL 32605-5814
Phone
(352) 336-2888
NPI assigned
Sep 5, 2013
Last updated
Apr 13, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP5640 MN
Clinical Child & Adolescent Psychologist 103TC2200X PY9003 FL Primary

Addresses

Primary practice location

2121 NW 40TH Ter Ste B
Gainesville, FL 32605-5814

Mailing address

2121 NW 40TH Ter Ste B
Gainesville, FL 32605-5814
Phone (352) 336-2888

Other identifiers 1

IdentifierTypeStateIssuer
017029900MedicaidFL

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180319001491 FL Practitioner - Clinical Psychologist 7517229180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2001 SW 13TH St
Gainesville, FL 32608-1532
Phone (352) 265-8990

Merit-based Incentive Payment System (MIPS)

Final score
47.54 of 100Reported as apm
Quality
38.49
Promoting interoperability
0
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LP5640MNMDClinical Psychologist
PY9003FLMDClinical Child & Adolescent Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Mar 1, 2018 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Mar 1, 2018 Accepting new patients
Ernest J Bordini PHD & Assoc PA Clinical Past Accepting new patients

Locations

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

1600 SW Archer Rd
#100371
Gainesville, FL 32610
Phone (352) 265-8335

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1378339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523577600000",
    "number": "1518392828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 NW 40TH TER STE B",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326055814",
            "telephone_number": "352-336-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 NW 40TH TER STE B",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326055814",
            "telephone_number": "352-336-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMERO",
        "first_name": "REGILDA ANNE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-05",
        "last_updated": "2018-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP5640",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "PY9003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017029900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.