Roberto A Nicodemo, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9101023 Issued in FL

Practice address

1044 Plaza Dr
Kissimmee, FL 34743-4064

Phone

(407) 350-5659

Fax

(407) 350-5662

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1990

Medicare assignment

May accept Medicare assignment

Group practices

Heisu Research Group LLCGroup PAC ID 5890147490, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Heisu Research Group LLC

  • Research Clinic/Center
  • North Miami Beach, FL
  • NPI 1588393060
  Medicare reassignment Care Compare group
• Serenity Life Counseling Center LLC

  • Addiction (Substance Use Disorder) Counselor
  • Kissimmee, FL
  • NPI 1346725413
  Medicare reassignment NPD
• Alpha Medical Center Corp

  • General Practice Physician
  • West Miami, FL
  • NPI 1346295334
  NPD (past)
• Jose M Gonzalez-Canal P a

  • Psychiatry Physician
  • Port Charlotte, FL
  • NPI 1568514073
  NPD (past)
• Medical Home Alliance LLC

  • Non-Pharmacy Dispensing Site
  • Winter Haven, FL
  • NPI 1033648233
  NPD (past)
• VKJ Associates Corp

  • Clinic/Center
  • Naples, FL
  • NPI 1447959028
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1831112416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6675 WESTWOOD BLVD STE 475",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328216027",
            "telephone_number": "407-845-0330",
            "fax_number": "888-972-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 PLAZA DR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347434064",
            "telephone_number": "407-350-5659",
            "fax_number": "407-350-5662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICODEMO",
        "first_name": "ROBERTO",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "PA9101023",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Federico Nicholas, PTA20728
• Chyna Nichols
• Aldrea Y Nicholson
• Isaiah Nicholson
• James Nickson
• Sarah Veronica Nicola, CNM, WHNP-BC
• Emily Nidhan
• Arianni Niebla-Bello
• Yissette Nieto Urena, DMD
• Diana Katherine Nieto, PA-C

• Physician Assistant in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.