Individual provider Active NPI

Gino Alberto Jr., DO

  • Emergency Medicine Physician
  • Palm City, FL
National Provider Identifier
1629188388
Registry record updated Jun 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
02001921A Issued in IN
Practice address
12831 NW Cinnamon Way
Palm City, FL 34990-4880
Phone
(772) 807-5531
NPI assigned
Aug 30, 2006
Last updated
Jun 22, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 02001921A IN Primary

Addresses

Primary practice location

12831 NW Cinnamon Way
Palm City, FL 34990-4880

Mailing address

12831 NW Cinnamon Way
Palm City, FL 34990-4880

Other identifiers 2

IdentifierTypeStateIssuer
200289160MedicaidIN
000000112218OtherINANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1538ALMDPsychologist
02001921AINMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Professionals of Indiana, P.C. Emergency Medicine Past Accepting new patients
Emergency Physician Associates of Ohio, Inc Emergency Medicine Past Accepting new patients
JTDM Family Practice LLC Past Accepting new patients
University Emergency Medicine Emergency Medicine Past Accepting new patients
Indiana Emergency Professionals PC Emergency Medicine Past Accepting new patients
Emgi-Wishard Emergency Medicine Past Accepting new patients
Icem-Wishard LLC Emergency Medicine Past Accepting new patients

Organizations & group practices 7

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466553600000",
    "number": "1629188388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12831 NW CINNAMON WAY",
            "city": "PALM CITY",
            "state": "FL",
            "postal_code": "349904880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12831 NW CINNAMON WAY",
            "city": "PALM CITY",
            "state": "FL",
            "postal_code": "349904880",
            "telephone_number": "772-807-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALBERTO",
        "first_name": "GINO",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2016-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "02001921A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200289160",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000112218",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.