Individual provider Active NPI

Emmanuel Octavio Gomez

  • Mental Health Counselor
  • St Petersburg, FL
National Provider Identifier
1750997177
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
4010 Central Ave
St Petersburg, FL 33711-1239
Phone
(727) 327-7656
NPI assigned
Sep 21, 2020
Last updated
Sep 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

4010 Central Ave
St Petersburg, FL 33711-1239

Mailing address

PO Box 10970
St Petersburg, FL 33733-0970

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240503001978 FL Practitioner - Mental Health Counselor 0648610956 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Betterment Mental Health Counseling, Inc.Group PAC ID 6709249642, 8 clinicians

Practice addresses (Care Compare)

1303 10TH St E
Suite a
Palmetto, FL 34221-4120
Phone (941) 800-4924

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Betterment Mental Health Counseling, Inc. CurrentSince Apr 24, 2024 Accepting new patients

Locations

1303 10th St E
Ste A
Palmetto, FL 34221
Phone (941) 800-4924

4242 S Tamiami Trl
Venice, FL 34293
Phone (941) 800-4924

Organizations & group practices 1

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": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1750997177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10970",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337330970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337111239",
            "telephone_number": "727-327-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "EMMANUEL",
        "middle_name": "OCTAVIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-21",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.