NPIMap

Individual provider Active NPI

Jorge Gomez, MD

  • Cardiovascular Disease Physician
  • Lake Mary, FL
National Provider Identifier
1568443356
Registry record updated Dec 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME0015929 Issued in FL
Practice address
1355 South International Parkway
Suite 1451
Lake Mary, FL 32746-1694
Phone
(407) 333-9888
Fax
(407) 333-9444
NPI assigned
Nov 8, 2005
Last updated
Dec 20, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X ME0015929 FL Primary

Addresses

Primary practice location

1355 South International Parkway
Suite 1451
Lake Mary, FL 32746-1694

Mailing address

1355 South International Parkway
Suite 1451
Lake Mary, FL 32746-1694
Phone (407) 333-9888

Other identifiers 2

IdentifierTypeStateIssuer
049702900MedicaidFL
112886230OtherZR MED

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050630000616 FL Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 0143266031 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1964
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

1355 S International Pkwy
Lake Mary, FL 32746-1694

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15929FLMDOrthodontics and Dentofacial Orthopedic Dentist

Organizations & group practices 1

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545264000000",
    "number": "1568443356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 SOUTH INTERNATIONAL PARKWAY",
            "address_2": "SUITE 1451",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461694",
            "telephone_number": "407-333-9888",
            "fax_number": "407-333-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 SOUTH INTERNATIONAL PARKWAY",
            "address_2": "SUITE 1451",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461694",
            "telephone_number": "407-333-9888",
            "fax_number": "407-333-9444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "JORGE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2018-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME0015929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "049702900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ZR MED",
            "identifier": "112886230",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.