| Dr Kimberly Ann Bruno-de La Mata, MD | |
|
13506 Summerport Village Pkwy, #341, Windermere, FL 34786-7366 | |
| (865) 363-3330 | |
| Not Available |
| Full Name | Dr Kimberly Ann Bruno-de La Mata |
|---|---|
| Gender | Female |
| Speciality | Internal Medicine |
| Experience | 31 Years |
| Location | 13506 Summerport Village Pkwy, Windermere, Florida |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548216419 | NPI | - | NPPES |
| 3856126 | Medicaid | TN | |
| 4103352 | Other | TN | BLUE CROSS |
| P00284603 | Other | TN | RRGA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | ME101735 (Florida) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Mon Health Medical Center | Morgantown, WV | Hospital |
| Uf Health Leesburg Hospital | Leesburg, FL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Mon Health Marion Neighborhood Hospital, Inc. | 3476943101 | 15 |
| Monongalia County General Hospital Company | 9638073380 | 212 |
| Entity Name | Monongalia County General Hospital Company |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1447673223 PECOS PAC ID: 9638073380 Enrollment ID: O20031124000459 |
| Entity Name | West Virginia Emergency Physicians Llp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1952776379 PECOS PAC ID: 7618270323 Enrollment ID: O20160128002708 |
| Entity Name | Mon Health Marion Neighborhood Hospital, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1417521337 PECOS PAC ID: 3476943101 Enrollment ID: O20220222000913 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Kimberly Ann Bruno-de La Mata, MD 1200 J D Anderson Dr, Morgantown, WV 26505-3494 Ph: (304) 598-1200 | Dr Kimberly Ann Bruno-de La Mata, MD 13506 Summerport Village Pkwy, #341, Windermere, FL 34786-7366 Ph: (865) 363-3330 |
Dr. Mariano De La Mata, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 13506 Summerport Village Pkwy, #341, Windermere, FL 34786 Phone: 865-406-9069 | |
Dr. Brian Wiboon, DO Emergency Medicine Medicare: Medicare Enrolled Practice Location: 5143 Tildens Grove Blvd, Windermere, FL 34786 Phone: 407-656-9908 Fax: 407-656-9908 |