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WIDDLER DESHOMMES MD
NPI 1376172015
General Practice in Mount Dora, FL

Active since April 04, 2020PECOS Enrolled
4601 N HIGHWAY 19A, MOUNT DORA, FL 32757(352) 290-8718 Get Directions Write a Review

NPPES record last updated: March 8, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 8, 2024, Feb 6, 2024, Jul 21, 2022 and 1 more (4 updates tracked since 2020).

About Widdler Deshommes Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WIDDLER DESHOMMES MD (NPI 1376172015) is an individual general practice provider in Mount Dora, Florida, licensed in Florida (ACN1610) and active in the NPI registry since April 2020. He is enrolled in Medicare PECOS and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1376172015
Entity TypeIndividualMale
Primary Taxonomy208D00000X
Provider Legal NameWIDDLER DESHOMMESCredential: MD
Location Address4601 N HIGHWAY 19AMount Dora, FL 32757-2039
Mailing Address550 Rouzer StApopka, FL 32712-3650 · (407) 575-0943
Phone(352) 290-8718
Sole ProprietorNo
Enumeration DateApril 4, 2020
Last NPPES UpdateMarch 8, 20244 updates tracked since enumeration
NPPES CertifiedMarch 8, 2024
✔ NPI 1376172015 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Licenses✔ Licensed in FL · ACN1610✔ Licensed in PR · 023661
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedPhysician AssistantTaxonomy 363A00000X · License 000229-P.A (PR), 8363 (AZ), TPPA363 (FL)
4601 N HIGHWAY 19A, Mount Dora, FL 32757
Open in Google Maps ↗

Secondary Practice Locations 3

Location 14540 E Baseline Rd Ste 105Mesa, AZ 85206-4616 · Phone (480) 272-8944 · Fax (480) 237-5682
Location 2425 S Hunt Club Blvd Ste 201Apopka, FL 32703-2428 · Phone (407) 304-9337
Location 355 Calle PalmaArecibo, PR 00612-4526 · Phone (787) 650-1030

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama, Health First Commercial Plans, Inc. and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Widdler Deshommes Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Widdler Deshommes reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Alina Community Center At Mount Dora LLC
Same address
Family Medicine
4601 N HIGHWAY 19A
Mount Dora, FL 32757
  • Reassigned Medicare billing, Florida enrollment
  • 7 clinicians in this Medicare group
NPI 1811550346 (352) 602-7924
Elite Med Family Care Inc
39 mi
Primary Care
1020 W OAK ST STE B
Kissimmee, FL 34741
  • Reassigned Medicare billing, Florida enrollment
  • 2 clinicians in this Medicare group
NPI 1164229985 (407) 449-4204
Alina Health Medical Center Corp.
202 mi
Family Medicine
4800 N STATE ROAD 7 STE C
Lauderdale Lakes, FL 33319
  • Reassigned Medicare billing, Florida enrollment
  • 4 clinicians in this Medicare group
NPI 1144975418 (305) 767-0887

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SAMUEL JOSEPH PA-C, MD
Physician Assistant
4601 N HIGHWAY 19A
MOUNT DORA, FL 32757
Orange County (352) 602-7924
AMANCIA NORMIL
Nurse Practitioner (Psychiatric/Mental Health)
4601 N HIGHWAY 19A
MOUNT DORA, FL 32757
Orange County (954) 884-5859
ALINA COMMUNITY CENTER AT MOUNT DORA LLC
Family Medicine
4601 N HIGHWAY 19A
MOUNT DORA, FL 32757
Orange County (352) 602-7924
ALINA COMMUNITY CENTER AT MOUNT DORA LLC
Clinic/Center (Mental Health (Including Community Mental Health Center))
4601 N HIGHWAY 19A
MOUNT DORA, FL 32757
Orange County (352) 602-7924
FERNHILL FAMILY MEDICINE LLC
Family Medicine
4601 N HIGHWAY 19A
MOUNT DORA, FL 32757
Orange County (352) 589-9090

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Widdler Deshommes's NPI number?

The NPI number for Widdler Deshommes is 1376172015. It was assigned to this individual provider in the NPPES registry on April 4, 2020.

Where is Widdler Deshommes located?

Widdler Deshommes practices at 4601 N Highway 19A, Mount Dora, FL 32757. The listed phone number is (352) 290-8718.

What is Widdler Deshommes's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Widdler Deshommes enrolled in Medicare?

Yes. Widdler Deshommes is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Widdler Deshommes's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Widdler Deshommes reassigns Medicare benefits to 3 organizations: Alina Community Center At Mount Dora LLC (Mount Dora, FL), Elite Med Family Care Inc (Kissimmee, FL) and Alina Health Medical Center Corp. (Lauderdale Lakes, FL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Widdler Deshommes's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Widdler Deshommes accept?

Health plans from Ambetter Health, Ambetter of Alabama, Health First Commercial Plans, Inc. and Oscar Health Maintenance Organization of Florida list Widdler Deshommes as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Widdler Deshommes was last updated on March 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.