Organization Active NPI

Mark G Brooks M D P a

  • Internal Medicine Physician
  • Gotha, FL
National Provider Identifier
1629066907
Registry record updated Oct 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0070398 Issued in FL
Legal business name
MARK G BROOKS M D P A
Practice address
3872 Old Winter Garden Rd
Suite 300 B
Gotha, FL 34734
Phone
(407) 578-6610
Fax
(407) 578-2247
NPI assigned
Oct 11, 2005
Last updated
Oct 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2026

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

Authorized official

Name
Ida Bonilla
Title
PA
Phone
(407) 578-6610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME0070398 FL Primary

Addresses

Primary practice location

3872 Old Winter Garden Rd
Suite 300 B
Gotha, FL 34734

Mailing address

3872 Old Winter Garden Rd
Suite 300 B
Gotha, FL 34734
Phone (407) 578-6610

Other identifiers 2

IdentifierTypeStateIssuer
110221576OtherFLRAILROAD MEDICARE
97989OtherFLBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040908000866 FL Part B Supplier - Clinic/Group Practice 9537135827 Receives reassigned benefits from 3 practitioners
Practice locations: Ocoee, FL

National Provider Directory

National Provider Directory

Locations

3872 Old Winter Garden Rd
Ste 300
Gotha, FL 34734
Phone (407) 578-6610

10000 W Colonial Dr
Ste 180
Ocoee, FL 34761

10000 W Colonial Dr
Ste 187
Ocoee, FL 34761
Phone (407) 521-3500

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790899200000",
    "number": "1629066907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3872 OLD WINTER GARDEN RD",
            "address_2": "SUITE 300 B",
            "city": "GOTHA",
            "state": "FL",
            "postal_code": "34734",
            "telephone_number": "407-578-6610",
            "fax_number": "407-578-2247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3872 OLD WINTER GARDEN RD",
            "address_2": "SUITE 300 B",
            "city": "GOTHA",
            "state": "FL",
            "postal_code": "34734",
            "telephone_number": "407-578-6610",
            "fax_number": "407-578-2247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK G BROOKS M D P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2026-10-02",
        "certification_date": "2026-09-29",
        "status": "A",
        "authorized_official_last_name": "BONILLA",
        "authorized_official_first_name": "IDA",
        "authorized_official_title_or_position": "PA",
        "authorized_official_telephone_number": "407-578-6610"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0070398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110221576",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "97989",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gotha, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2026; 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.