Individual provider Active NPI

Rosalynn Ventura Mondragon, MD

  • General Practice Physician
  • Tampa, FL
National Provider Identifier
1679989032
Registry record updated Nov 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN1165 Issued in FL
Practice address
3505 E Hillsborough Ave Ste 101
Tampa, FL 33610-4547
Phone
(813) 415-0100
Fax
(813) 415-0200
NPI assigned
Jul 7, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X ACN1165 FL Primary

Addresses

Primary practice location

3505 E Hillsborough Ave Ste 101
Tampa, FL 33610-4547

Mailing address

PO Box 4189
Deerfield Beach, FL 33442-4189
Phone (954) 363-9582

Other identifiers 1

IdentifierTypeStateIssuer
106537400MedicaidFL

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
I20200619000365 FL Practitioner - General Practice 1456631399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Consultants of Florida LLCGroup PAC ID 6002988847, 35 clinicians

Practice addresses (Care Compare)

3505 E Hillsborough Ave
Suite 102
Tampa, FL 33610-4547
Phone (813) 415-0100

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Consultants of Florida, LLC General Practice CurrentSince Nov 18, 2022 Accepting new patients
Patient Medical Center of Florida Inc General Practice PastSince Apr 4, 2018 Accepting new patients

Locations

819 N Central Ave
Kissimmee, FL 34741
Phone (407) 288-8242

672 SW Prima Vista Blvd
Ste 101
Port St Lucie, FL 34983
Phone (772) 905-2555

3505 E Hillsborough Ave
Ste 102
Tampa, FL 33610
Phone (813) 415-0100

3505 E Hillsborough Ave
Ste 101
Tampa, FL 33610
Phone (813) 415-0100

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1679989032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4189",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334424189",
            "telephone_number": "954-363-9582",
            "fax_number": "954-363-9663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 E HILLSBOROUGH AVE STE 101",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336104547",
            "telephone_number": "813-415-0100",
            "fax_number": "813-415-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENTURA MONDRAGON",
        "first_name": "ROSALYNN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-07",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106537400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.