Individual provider Active NPI

Maria Gina Tiomico, M.D.

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1982717401
Registry record updated Dec 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME70793 Issued in FL
Practice address
4266 Sunbeam Rd
Jacksonville, FL 32257-2425
Phone
(904) 268-5200
NPI assigned
Aug 17, 2006
Last updated
Dec 18, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME70793 FL Primary

Addresses

Primary practice location

4266 Sunbeam Rd
Jacksonville, FL 32257-2425

Mailing address

4266 Sunbeam Rd
Jacksonville, FL 32257-2425
Phone (904) 268-5200

Other identifiers 2

IdentifierTypeStateIssuer
267954366MedicaidFL
250212700MedicaidFL

Other names 1

  • Maria Gina De Guzman Tiomico Former name

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
I20160628002435 FL Order and Referring Only - Family PracticePractitioner - Family Practice 0244296192

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME70793FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Family Practice Associates, LLC Family Medicine Past Accepting new patients
Solantic LLC Past Accepting new patients
Tiomico-Trahan Family Care Center PA Family Medicine PastSince Oct 14, 2004 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545091200000",
    "number": "1982717401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4266 SUNBEAM RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322572425",
            "telephone_number": "904-268-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4266 SUNBEAM RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322572425",
            "telephone_number": "904-268-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIOMICO",
        "first_name": "MARIA",
        "middle_name": "GINA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2018-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME70793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267954366",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250212700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA GINA",
            "last_name": "TIOMICO",
            "middle_name": "DE GUZMAN",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.