Individual provider Active NPI

Antonio C Gomes, MD

  • Internal Medicine Physician
  • Saint Cloud, FL
National Provider Identifier
1962500892
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0046927 Issued in FL
Practice address
2906 17TH St
Saint Cloud, FL 34769-6006
Phone
(407) 425-4847
Fax
(904) 346-0113
NPI assigned
Sep 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME0046927 FL Primary

Addresses

Primary practice location

2906 17TH St
Saint Cloud, FL 34769-6006

Mailing address

PO Box 628296
Orlando, FL 32862-8296
Phone (407) 741-9418

Other identifiers 2

IdentifierTypeStateIssuer
0422036100MedicaidFL
47778OtherFLBCBS

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
I20111110000516 FL Practitioner - Emergency Medicine 5294909107 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0046927FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of Central Florida LLP CurrentSince Jan 1, 1998 Accepting new patients

Locations

555 W State Road 434
Longwood, FL 32750
Phone (407) 767-1200

1414 S Orange Ave
#112
Orlando, FL 32806
Phone (407) 767-1200

2906 17th St
Saint Cloud, FL 34769
Phone (407) 425-4847

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": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962500892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 628296",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328628296",
            "telephone_number": "407-741-9418",
            "fax_number": "904-346-0113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2906 17TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347696006",
            "telephone_number": "407-425-4847",
            "fax_number": "904-346-0113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMES",
        "first_name": "ANTONIO",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0046927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0422036100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "47778",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, FL

Sources for this page

Verify at the official NPI Registry.