Widdler Deshommes, MD is a medicare enrolled "General Practice" in Mount Dora, Florida. His current practice location is
4601 N Highway 19a, Mount Dora, Florida. You can reach out to his office (for appointments etc.) via phone at
(352) 290-8718.
Widdler Deshommes is licensed to practice in Florida (license number ACN1610) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1376172015.
Provider's Profile
| Full Name | Widdler Deshommes |
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| Gender | Male |
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| Speciality | General Practice |
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| Location | 4601 N Highway 19a, Mount Dora, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1376172015
- Provider Enumeration Date: 04/04/2020
- Last Update Date: 03/08/2024
Medicare PECOS Information:
- PECOS PAC ID: 9739565169
- Enrollment ID: I20240408001798
Medical Identifiers
Medical identifiers for Widdler Deshommes such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1376172015 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | 000229-P.A (Puerto Rico) | Secondary |
| 363A00000X | Physician Assistant | 8363 (Arizona) | Secondary |
| 363A00000X | Physician Assistant | TPPA363 (Florida) | Secondary |
| 208D00000X | General Practice | 023661 (Puerto Rico) | Secondary |
| 208D00000X | General Practice | ACN1610 (Florida) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Widdler Deshommes allows following entities to bill medicare on his behalf.
| Entity Name | Alina Health Medical Center Corp |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1144975418
PECOS PAC ID: 7517352214
Enrollment ID: O20220316000743 |
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| Entity Name | Elite Med Family Care Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1164229985
PECOS PAC ID: 9931619608
Enrollment ID: O20250611001772 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Widdler Deshommes is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Widdler Deshommes, MD
550 Rouzer St,
Apopka, FL 32712-3650
Ph: (407) 575-0943 | Widdler Deshommes, MD
4601 N Highway 19a,
Mount Dora, FL 32757-2039
Ph: (352) 290-8718 |
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