Organization Active NPI

Mario Gomez MD PA

  • Obstetrics & Gynecology Physician
  • Homestead, FL
National Provider Identifier
1538458153
Registry record updated Apr 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
ME102113 Issued in FL
Legal business name
MARIO GOMEZ MD PA
Practice address
925 NE 30TH Ter
Suite 300
Homestead, FL 33033-7613
Phone
(786) 256-4174
NPI assigned
Apr 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2011

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

Authorized official

Name
Mario Gomez, MDNPI 1033386131
Title
President
Phone
(786) 256-4174

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X ME102113 FL Primary

Addresses

Primary practice location

925 NE 30TH Ter
Suite 300
Homestead, FL 33033-7613

Mailing address

8775 SW 164 St
Palmetto Bay, FL 33157-3562
Phone (786) 256-4174

Other identifiers 1

IdentifierTypeStateIssuer
001046400MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110524000220 FL Part B Supplier - Clinic/Group Practice 0941486104 Receives reassigned benefits from 1 practitioner
Practice locations: Homestead, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2027399Mario Gomez MD PA925 NE 30TH Terr Ste 300, Homestead, FL 33033Certificate of waiverJul 24, 2027

National Provider Directory

National Provider Directory

Locations

925 NE 30th Ter
Ste 304
Homestead, FL 33033
Phone (786) 377-2500

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301961600000",
    "number": "1538458153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8775 SW 164 ST",
            "city": "PALMETTO BAY",
            "state": "FL",
            "postal_code": "331573562",
            "telephone_number": "786-256-4174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 NE 30TH TER",
            "address_2": "SUITE 300",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330337613",
            "telephone_number": "786-256-4174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIO GOMEZ MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-05",
        "last_updated": "2011-04-05",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-256-4174",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME102113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001046400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Homestead, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.