Individual provider Active NPI

William Rodriguez Fundora, D.O.

  • Family Medicine Physician
  • Miami, FL
National Provider Identifier
1821059312
Registry record updated Dec 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS-0007275 Issued in FL
Practice address
1100 SW 57 Ave #101
Miami, FL 33144
Phone
(305) 644-1550
Fax
(305) 269-1068
NPI assigned
Apr 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS0007275 FL
Family Medicine Physician 207Q00000X OS-0007275 FL Primary

Addresses

Primary practice location

1100 SW 57 Ave #101
Miami, FL 33144

Mailing address

1100 SW 57 Ave #101
Miami, FL 33144
Phone (305) 644-1550

Other identifiers 1

IdentifierTypeStateIssuer
260231800MedicaidFL

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
I20090110000014 FL Practitioner - Family Practice 0749279289 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rodriguez and Sixto Medical Associates, P.a.Group PAC ID 8022007665, 2 clinicians

Practice addresses (Care Compare)

1100 SW 57TH Ave
Suite 101
Miami, FL 33144-5129
Phone (305) 644-1550

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS-0007275FLMDFamily Medicine Physician
OS0007275FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rodriguez and Sixto Medical Associates, P.a. Family Medicine CurrentSince Jan 12, 2000 Accepting new patients

Locations

1100 SW 57th Ave
Ste 101
West Miami, FL 33144
Phone (305) 644-1550

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.

NPI Registry JSON

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

{
    "created_epoch": "1143849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230076800000",
    "number": "1821059312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SW 57 AVE #101",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33144",
            "telephone_number": "305-644-1550",
            "fax_number": "305-269-1068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SW 57 AVE #101",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33144",
            "telephone_number": "305-644-1550",
            "fax_number": "305-269-1068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ FUNDORA",
        "first_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-01",
        "last_updated": "2008-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS0007275",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS-0007275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260231800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.