NPIMap

Individual provider Active NPI

Fausto Ronald Burgos, M.D.

  • Family Medicine Physician
  • Orlando, FL
National Provider Identifier
1679503486
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME0062672 Issued in FL
Practice address
12301 Lake Underhill Rd Ste 215
Orlando, FL 32828-4511
Phone
(321) 235-0692
Fax
(321) 235-0694
NPI assigned
Jul 4, 2006
Last updated
Mar 17, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME0062672 FL Primary

Addresses

Primary practice location

12301 Lake Underhill Rd Ste 215
Orlando, FL 32828-4511

Mailing address

4034 Greenleaf Dr
Kissimmee, FL 34744-9150
Phone (407) 242-0293

Other identifiers 1

IdentifierTypeStateIssuer
115750100MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100917000560 FL Practitioner - Family Practice 2860436821 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12301 Lake Underhill Rd
Suite 215
Orlando, FL 32828-4508

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0062672FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
HGM Orlando LLC Family Medicine Current Accepting new patients
Primary Healthcare Associates, Inc CurrentSince May 21, 2013 Accepting new patients
Hospitalist Medicine Physicians of Florida - Jacksonville II LLC CurrentSince Mar 12, 2024 Accepting new patients
The Family Physician of BVL CurrentSince Oct 1, 2000 Accepting new patients
Lobato Family Practice Past Accepting new patients
The Family Doctors of Buena Ventura PA Family Medicine Past Accepting new patients

Locations

785 S 2nd St
Defuniak Springs, FL 32435
Phone (850) 892-2176

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

201 Hilda St
Ste 38
Kissimmee, FL 34741
Phone (407) 629-8865

3071 Michigan Ave
Kissimmee, FL 34744
Phone (407) 348-9111

308 W Bass St
Kissimmee, FL 34741
Phone (407) 483-8801

2250 Indian Creek Blvd W
Vero Beach, FL 32966
Phone (772) 562-7400

Organizations & group practices 6

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742169600000",
    "number": "1679503486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4034 GREENLEAF DR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347449150",
            "telephone_number": "407-242-0293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 LAKE UNDERHILL RD STE 215",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328284511",
            "telephone_number": "321-235-0692",
            "fax_number": "321-235-0694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGOS",
        "first_name": "FAUSTO",
        "middle_name": "RONALD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0062672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115750100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.