Mydr Family Clinic, PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MYDR FAMILY CLINIC, PA

Practice address

1952 N John Young Pkwy
Kissimmee, FL 34741-3221

Phone

(407) 978-6605

Fax

(407) 978-6610

NPI assigned

Mar 23, 2020

Organization subpart

No

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

Authorized official

Name

Caridad Gonzalez, MDNPI 1033489042

Title

Owner

Phone

(407) 978-6605

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 2

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

• Caridad Gonzalez, M.D.

  • General Practice Physician
  • Kissimmee, FL
  • NPI 1033489042
  Medicare reassignment NPD Authorized official
• Raydelys Camejo

  • Family Nurse Practitioner
  • Orlando, FL
  • NPI 1972120376
  Medicare reassignment NPD

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

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1619504479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1962 N JOHN YOUNG PKWY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347413221",
            "telephone_number": "407-978-6605",
            "fax_number": "407-978-6610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1952 N JOHN YOUNG PKWY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347413221",
            "telephone_number": "407-978-6605",
            "fax_number": "407-978-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYDR FAMILY CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-23",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "CARIDAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-978-6605",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Amy Myler

• 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 May 24, 2021; 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.