Active NPI
Eleazar Domingo Fariscal, DO, DPT
- General Practice Physician
- Gainesville, FL
National Provider Identifier
1851619993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- OS21335
- Practice address
- 1600 SW Archer Rd
Gainesville, FL 32610-4638 - Phone
- (352) 757-0660
- NPI assigned
- May 13, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 11023156A | IN | |
| Physical Therapist | 225100000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Physician | 208D00000X | OS21335 | FL | Primary |
Addresses
Primary practice location
1600 SW Archer Rd
Gainesville, FL 32610-4638
Mailing address
9005 SW 70TH LN
Gainesville, FL 32608-5394
Phone (248) 205-0575
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241206003584 | FL | Order and Referring Only - Physical Medicine and Rehabilitation | 6709917800 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Interoperability endpoints
- eleazar.fariscal.p4@direct.athleticoltd.nextgenshare.com
- efariscal709386@direct.shands.ufl.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732320000000",
"number": "1851619993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9005 SW 70TH LN",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326085394",
"telephone_number": "248-205-0575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 SW ARCHER RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326104638",
"telephone_number": "352-757-0660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARISCAL",
"first_name": "ELEAZAR",
"middle_name": "DOMINGO",
"name_prefix": "Dr.",
"credential": "DO, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-05-13",
"last_updated": "2024-11-23",
"certification_date": "2024-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IN",
"license": "11023156A",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "FL",
"license": "OS21335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.