Individual provider Active NPI

Wanda M Berrios, MD

  • Family Medicine Physician
  • Kissimmee, FL
National Provider Identifier
1932216496
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ACN699 Issued in FL
Practice address
3050 Michigan Ave
Kissimmee, FL 34744-1544
Phone
(407) 343-8335
Fax
(844) 388-6186
NPI assigned
Aug 23, 2006
Last updated
Aug 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 13686 PR
Family Medicine Physician 207Q00000X ACN699 FL Primary

Addresses

Primary practice location

3050 Michigan Ave
Kissimmee, FL 34744-1544

Mailing address

601 S Harbour Island Blvd Ste 200
Tampa, FL 33602-5925
Phone (727) 322-3439

Other identifiers 1

IdentifierTypeStateIssuer
ACN 699OtherFLFLORIDA MEDICAL LICENSE

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
I20170817001378 FL Practitioner - General Practice 8426156241 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Medical Associates LLCGroup PAC ID 0648271155, 162 clinicians

Practice addresses (Care Compare)

3050 Michigan Ave
Kissimmee, FL 34744-1544
Phone (407) 343-8335

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13686PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Medical Associates LLC CurrentSince May 1, 2018 Accepting new patients

Locations

3050 Michigan Ave
Kissimmee, FL 34744
Phone (407) 343-8335

13940 N US Highway 441
Ste 102
Lady Lake, FL 32159
Phone (352) 509-9900

4600 Mobile Hwy
#10
Pensacola, FL 32506
Phone (850) 407-4997

521 13th St
Saint Cloud, FL 34769
Phone (407) 556-6222

601 S Harbour Island Blvd
Ste 200
Tampa, FL 33602
Phone (727) 322-3439

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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.

Hospital & facility affiliations 4

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": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1932216496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S HARBOUR ISLAND BLVD STE 200",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336025925",
            "telephone_number": "727-322-3439",
            "fax_number": "800-928-7449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 MICHIGAN AVE",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347441544",
            "telephone_number": "407-343-8335",
            "fax_number": "844-388-6186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRIOS",
        "first_name": "WANDA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "13686",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ACN699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA MEDICAL LICENSE",
            "identifier": "ACN 699",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.