Icmd PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ICMD PA

Practice address

10770 SE 173Rd St
Summerfield, FL 34491-6851

Phone

(352) 455-2026

Fax

(352) 748-2700

NPI assigned

Jan 18, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Fariborz Delbakhsh, MDNPI 1548299712

Title

Owner, President

Phone

(352) 455-2026

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fariborz Delbakhsh, M.D.

  • Specialist
  • Summerfield, FL
  • NPI 1548299712
  Medicare reassignment NPD Authorized official
• Anthony Arias Bravo

  • Family Nurse Practitioner
  • Ocala, FL
  • NPI 1508467374
  Medicare reassignment NPD
• Jocelyn Cecile Eslinger, ARNP

  • Family Nurse Practitioner
  • Summerfield, FL
  • NPI 1083159107
  Medicare reassignment NPD
• Derrick J Martin Sr., MD

  • Internal Medicine Physician
  • Summerfield, FL
  • NPI 1104980812
  Medicare reassignment NPD
• Debra Fonseca, ARNP-C

  • Family Nurse Practitioner
  • Chattanooga, TN
  • NPI 1073967287

  FL

  Medicare reassignment NPD
• Marissa Rae Reit, PA-C

  • Physician Assistant
  • Summerfield, FL
  • NPI 1437633070
  Medicare reassignment
• Florines Gonzalez, ARNP, FNP-BC

  • Primary Care Nurse Practitioner
  • Summerfield, FL
  • NPI 1093653826
  NPD

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

{
    "created_epoch": "1610928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610928000000",
    "number": "1962091520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10770 SE 173RD ST",
            "city": "SUMMERFIELD",
            "state": "FL",
            "postal_code": "344916851",
            "telephone_number": "352-455-2026",
            "fax_number": "352-748-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10770 SE 173RD ST",
            "city": "SUMMERFIELD",
            "state": "FL",
            "postal_code": "344916851",
            "telephone_number": "352-455-2026",
            "fax_number": "352-748-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4767 County Road 466A",
            "address_purpose": "LOCATION",
            "city": "Wildwood",
            "state": "FL",
            "postal_code": "347853616",
            "country_code": "US",
            "telephone_number": "352-435-7321",
            "fax_number": "352-748-2700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "33006 Professional Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Leesburg",
            "state": "FL",
            "postal_code": "347887510",
            "country_code": "US",
            "telephone_number": "352-435-7321",
            "fax_number": "352-748-2700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ICMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-18",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "DELBAKHSH",
        "authorized_official_first_name": "FARIBORZ",
        "authorized_official_title_or_position": "OWNER, PRESIDENT",
        "authorized_official_telephone_number": "352-455-2026",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dawn Hubbard, LMT
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• Alfredo Jacome, M.D., P.A.
• John S. Geddes III OD PA

• Internal Medicine Physician in Summerfield, FL
• Providers in Summerfield, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.