Family Tree Medical Group, PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

FAMILY TREE MEDICAL GROUP, PA

Practice address

1150 Cypress Glen Cir
Kissimmee, FL 34741-7560

Phone

(407) 483-3200

Fax

(407) 483-3220

NPI assigned

Aug 21, 2015

Last updated

Oct 28, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Victor Manuel Pantoja Jr., CEO

Title

Ceo

Phone

(407) 483-3200

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jean Carlos Martinez Cruz, M.D.

  • General Practice Physician
  • Saint Cloud, FL
  • NPI 1497100952
  Medicare reassignment NPD
• Raymond Rodriguez Negron, M.D.

  • General Practice Physician
  • Kissimmee, FL
  • NPI 1154874584
  Medicare reassignment NPD
• Daniel Rivero de Jesus, M.D.

  • General Practice Physician
  • Kissimmee, FL
  • NPI 1730289505
  NPD
• Carlos Alexis Estrella Gonzalez, M.D.

  • Pediatrics Physician
  • Clermont, FL
  • NPI 1073843991

  Single Specialty

  NPD (past)
• Francelis Ivette Gonzalez, MD

  • Pediatrics Physician
  • Kissimmee, FL
  • NPI 1972580322
  NPD (past)
• Michelle Denisse Herrera, M.D

  • Pediatrics Physician
  • Orlando, FL
  • NPI 1659724151
  NPD (past)
• Antonio Quinones, APRN

  • Family Nurse Practitioner
  • Davenport, FL
  • NPI 1851267942
  NPD (past)

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

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1609243989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 CYPRESS GLEN CIR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347417560",
            "telephone_number": "407-483-3200",
            "fax_number": "407-483-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 CYPRESS GLEN CIR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347417560",
            "telephone_number": "407-483-3200",
            "fax_number": "407-483-3220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2201 North Blvd W Ste 2",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "FL",
            "postal_code": "338378990",
            "country_code": "US",
            "telephone_number": "863-353-1246",
            "fax_number": "863-419-9547",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 W Carroll St Ste 2",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347411268",
            "country_code": "US",
            "telephone_number": "407-201-3348",
            "fax_number": "407-518-0094",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY TREE MEDICAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-21",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A",
        "authorized_official_last_name": "PANTOJA",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "MANUEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-483-3200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "IV484A",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017306100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Family Life Services Ministries & Counseling, Inc
• Family Life Services Ministries & TCM, Inc.
• Family Medical Clinic, LLC
• Family Medicine at Kissimmee, LLC
• Family Members Behavioral Services, Inc.
• Schellie Michelle Fanfan, LMHC, MS, EDS
• Eleyn Fangonilo
• George Farag, RPH
• Stuart R Farber, MD
• Maria I Farfan

• General Practice Physician in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; 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.