Individual provider Active NPI

Alfonso Gonzalez-Rodriguez, MD

  • Internal Medicine Physician
  • Orlando, FL
National Provider Identifier
1629091384
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME111016 Issued in FL
Practice address
1707 N Mills Ave
Orlando, FL 32803-1851
Phone
(407) 647-3960
Fax
(407) 367-0856
NPI assigned
Jul 25, 2006
Last updated
Jan 11, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 16463 PR
Internal Medicine Physician 207R00000X ME111016 FL Primary

Addresses

Primary practice location

1707 N Mills Ave
Orlando, FL 32803-1851

Mailing address

917 Rinehart Rd
Ste 1051
Lake Mary, FL 32746-4853
Phone (407) 647-3960

Other identifiers 3

IdentifierTypeStateIssuer
14HQ5OtherFLBCBS
P01092685OtherFLRAILROAD MEDICARE
008797500MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111031000337 FL Practitioner - Internal Medicine 1557453131 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME111016FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Florida Inpatient Medicine LLC Internal Medicine CurrentSince Nov 27, 2016 Accepting new patients
Orlando Immunology Center PA PastSince Jan 1, 2020 Accepting new patients
CMG Ambulance Services, Inc. PastSince Aug 17, 2007 Accepting new patients

Locations

525 Technology Park
Ste 109
Lake Mary, FL 32746
Phone 4076472346 ext. 111

917 Rinehart Rd
Ste 1051
Lake Mary, FL 32746
Phone (407) 562-9170

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484092800000",
    "number": "1629091384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 RINEHART RD",
            "address_2": "STE 1051",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327464853",
            "telephone_number": "407-647-3960",
            "fax_number": "407-367-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 N MILLS AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031851",
            "telephone_number": "407-647-3960",
            "fax_number": "407-367-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ-RODRIGUEZ",
        "first_name": "ALFONSO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2017-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PR",
            "license": "16463",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME111016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "14HQ5",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01092685",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008797500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.