| Community Medical Group | |
|
3805 W 20th Ave Ste 105 Hialeah FL 33012-4532 | |
| (305) 557-2277 | |
| (305) 557-2278 |
| Full Name | Community Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 3805 W 20th Ave Ste 105, Hialeah, Florida |
| Authorized Official Name and Position | Rayny Ramirez (PRESIDENT) |
| Authorized Official Contact | 7863227333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Medical Group 6100 Blue Lagoon Dr Suite 365 Miami FL 33126-2079 Ph: (786) 322-7333 | Community Medical Group 3805 W 20th Ave Ste 105 Hialeah FL 33012-4532 Ph: (305) 557-2277 |
| NPI Number | 1427330091 |
|---|---|
| Provider Enumeration Date | 09/09/2011 |
| Last Update Date | 05/25/2023 |
| Medicare PECOS PAC ID | 3971740705 |
|---|---|
| Medicare Enrollment ID | O20130726000260 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427330091 | NPI | - | NPPES |
| 009426905 | Medicaid | FL | |
| 009426900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mario R Palomino |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1043229164 PECOS PAC ID: 6709772221 Enrollment ID: I20040223000964 |
| Provider Name | Lizbett Rodriguez-varona |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346645462 PECOS PAC ID: 2961715842 Enrollment ID: I20150721002452 |
| Provider Name | Jorge Fong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629473707 PECOS PAC ID: 5698070308 Enrollment ID: I20160217002180 |
| Provider Name | Ileana Mustelier Pomares |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1649874868 PECOS PAC ID: 4587061171 Enrollment ID: I20210923003719 |
| Provider Name | Carmen Maria Urquijo Sarmiento |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346913951 PECOS PAC ID: 6709259849 Enrollment ID: I20230310000873 |
| Provider Name | Jose Nicolas Toboso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467067330 PECOS PAC ID: 7517332778 Enrollment ID: I20230331002412 |
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