Organization Active NPI

Her GYN, LLC

  • Gynecology Physician
  • Altamonte Springs, FL
National Provider Identifier
1710747738
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
Legal business name
HER GYN, LLC
Practice address
681 Douglas Ave Ste 109
Altamonte Springs, FL 32714-2583
Phone
(787) 505-9899
NPI assigned
Mar 19, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Authorized official

Name
Jesus Gutierrez
Title
Director
Phone
(787) 505-9989

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VG0400X Primary

Addresses

Primary practice location

681 Douglas Ave Ste 109
Altamonte Springs, FL 32714-2583

Mailing address

681 Douglas Ave Ste 109
Altamonte Springs, FL 32714-2583
Phone (321) 462-5050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240813004491 FL Part B Supplier - Clinic/Group Practice 1153869714 Receives reassigned benefits from 1 practitioner
Practice locations: Altamonte Springs, FL

National Provider Directory

National Provider Directory

Locations

5804 Lake Underhill Rd
Ste A
Orlando, FL 32807
Phone (407) 203-6898

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1710747738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "681 DOUGLAS AVE STE 109",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327142583",
            "telephone_number": "321-462-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "681 DOUGLAS AVE STE 109",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327142583",
            "telephone_number": "787-505-9899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HER GYN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "JESUS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "787-505-9989"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Altamonte Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.