Active NPI
Mario Sergio Blondin Fernandez
- Student in an Organized Health Care Education/Training Program
- Gainesville, FL
National Provider Identifier
1972234243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 4455 SW 34TH St Apt X126
Gainesville, FL 32608-6550 - Phone
- (786) 759-3645
- NPI assigned
- Jun 18, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
4455 SW 34TH St Apt X126
Gainesville, FL 32608-6550
Mailing address
4455 SW 34TH St Apt X126
Gainesville, FL 32608-6550
Phone (786) 759-3645
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | NONE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | None | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- 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 |
|---|---|---|---|---|
| I20250626002831 | NC | Order and Referring Only - Plastic and Reconstructive Surgery | 2264944933 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655510400000",
"number": "1972234243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4455 SW 34TH ST APT X126",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326086550",
"telephone_number": "786-759-3645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4455 SW 34TH ST APT X126",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326086550",
"telephone_number": "786-759-3645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLONDIN FERNANDEZ",
"first_name": "MARIO",
"middle_name": "SERGIO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-18",
"last_updated": "2022-06-18",
"certification_date": "2022-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NONE",
"identifier": "NONE",
"state": null
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "None",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "None",
"address_1": "4455 SW 34th St Apt X126",
"city": "Gainesville",
"state": "FL",
"country_code": "US",
"postal_code": "326086550",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Jun 18, 2022; 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.