Individual provider Active NPI

Ayezel Marina Munoz Gonzalez, MD

  • Dermatology Physician
  • Galveston, TX
National Provider Identifier
1780105056
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
S4026 Issued in TX
Practice address
1005 Harborside Dr, FL 5
Galveston, TX 77555-0001
Phone
(409) 747-3376
Fax
(409) 772-4456
NPI assigned
Jun 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X TX
Dermatology Physician 207N00000X S4026 TX Primary

Addresses

Primary practice location

1005 Harborside Dr, FL 5
Galveston, TX 77555-0001

Mailing address

PO Box 650859
Dept 710
Dallas, TX 75265-0859
Phone (409) 772-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20230602001075 TX Practitioner - Dermatology 9931521721 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utmb Faculty Group PracticeGroup PAC ID 3375456734, 1,083 clinicians

Practice addresses (Care Compare)

1005 Harborside Dr FL
Suite 5
Galveston, TX 77555-0001
Phone (409) 772-6781

Hospital & facility affiliations

  • University of Texas Medical Branch Galveston Hospital, Galveston, TX, CCN 450018

Merit-based Incentive Payment System (MIPS)

Final score
78.88 of 100Reported as group
Quality
73.38
Improvement activities
40
Cost
78.42

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions279
Removal of nail tissue1-10
Skin biopsy129

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
S4026TXMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utmb Faculty Group Practice Dermatology CurrentSince Jul 1, 2023 Accepting new patients

Locations

1005 Harborside Dr
Fl 5
Galveston, TX 77555
Phone (409) 747-3376

301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883

2660 Gulf Fwy S
Ste A
League City, TX 77573

2660 Gulf Fwy S
League City, TX 77573
Phone (832) 505-2100

Interoperability endpoints

  • Direct secure messaging: amunozgonzalezmd47714@direct.utmb.edu

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1780105056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650859",
            "address_2": "DEPT 710",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752650859",
            "telephone_number": "409-772-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 HARBORSIDE DR, FL 5",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775550001",
            "telephone_number": "409-747-3376",
            "fax_number": "409-772-4456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNOZ GONZALEZ",
        "first_name": "AYEZEL",
        "middle_name": "MARINA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "S4026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galveston, TX

Sources for this page

Verify at the official NPI Registry.