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GUSTAVO PLASENCIA M.D.
NPI 1386723567
Colon & Rectal Surgery in Miami, FL

Active since November 06, 2006PECOS EnrolledAccepts Medicare Assignment
87.41/100
CMS Quality Rating
9195 SUNSET DR, SUITE 230, MIAMI, FL 33173(786) 466-6960(305) 279-1994 Get Directions Write a Review

NPPES record last updated: October 1, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Gustavo Plasencia M.d. NPPES

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

GUSTAVO PLASENCIA M.D. (NPI 1386723567) is an individual colon & rectal surgery provider in Miami, Florida, licensed in Florida (ME0031262) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS, is affiliated with Jackson Health System, and is a graduate of Other (1974).

NPPES Registry Identity

NPI1386723567
Entity TypeIndividualMale
Primary Taxonomy208C00000X
Provider Legal NameGUSTAVO PLASENCIACredential: M.D.
Location Address9195 SUNSET DR, SUITE 230Miami, FL 33173-3452
Mailing Address9195 Sunset Dr, Suite 230Miami, FL 33173-3452 · (786) 466-6960 · Fax (305) 279-1994
Phone(786) 466-6960
Fax(305) 279-1994
Sole ProprietorYes
Medical School CMSOtherGraduated 1974
Enumeration DateNovember 6, 2006
Last NPPES UpdateOctober 1, 2014
✔ NPI 1386723567 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyColon & Rectal SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208C00000X
License✔ Licensed in FL · ME0031262
Definition
A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease.
Also ListedSurgeryTaxonomy 208600000X · License ME0031262 (FL)
9195 SUNSET DR, Miami, FL 33173
Open in Google Maps ↗

Other Identifiers 1

Medicare UPIND63687FL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Gustavo Plasencia M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID244256550
PECOS Enrollment IDI20051017000390
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.

Areas of Expertise CMS Part B claims 10

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
39 services39 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
28 services25 patients
Diagnostic exam of anus using an endoscope 46600
This procedure involves using a thin, flexible instrument called an endoscope to examine the anal area. It helps detect any abnormal conditions or issues. It's a safe, routine exam performed by a healthcare professional.
18 services16 patients
Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385
This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.
17 services16 patients
Biopsy of large bowel using a flexible endoscope 45380
A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.
16 services16 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
16 services13 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Jackson Health System

Acute Care Hospitals · Miami, FL
1/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number100022
Location1611 NW 12th AveMiami, FL 33136 · Miami-Dade County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33173 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.13 typical visit price
range $60.92 – $187.05
Typical copayment $24.03 (range $15.23 – $46.76)
Most-billed visit code 99203
Established Patient
$75.86 typical visit price
range $18.99 – $150.24
Typical copayment $18.96 (range $4.74 – $37.56)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

87.41/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality80.73
Improvement Activities40
Cost60.03

Other Providers at the Same Location NPPES 12

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

DR. JEFFREY ALAN LOMAN M.D
Internal Medicine
9195 SUNSET DR, 210
MIAMI, FL 33173
Miami-Dade County (305) 271-9065
PEDRO J CARVAJAL MD PA
Orthopaedic Surgery
9195 SUNSET DR, SUITE 100
MIAMI, FL 33173
Miami-Dade County (305) 598-3223
JEFFREY A LOMAN MD PA
Internal Medicine
9195 SUNSET DR, SUITE 210
MIAMI, FL 33173
Miami-Dade County (305) 271-9065
RENE F HARTMANN M.D.
Colon & Rectal Surgery
9195 SUNSET DR, SUITE 230
MIAMI, FL 33173
Miami-Dade County (305) 279-1994
DR. BARBARA M MUINA M.D
Internal Medicine
9195 SUNSET DR, STE 210
MIAMI, FL 33173
Miami-Dade County (305) 271-9065
PEDRO J. CARVAJAL, MD, PA
Non-Pharmacy Dispensing Site
9195 SUNSET DR, SUITE #100
MIAMI, FL 33173
Miami-Dade County (305) 598-3223
HENRY LUJAN MD LLC
Surgery
9195 SUNSET DR, SUITE 230
MIAMI, FL 33173
Miami-Dade County (305) 271-4814
GEORGE M SUAREZ M.D., P.A.
Urology
9195 SUNSET DR, SUITE 110
MIAMI, FL 33173
Miami-Dade County (305) 595-0199

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 Gustavo Plasencia's NPI number?

The NPI number for Gustavo Plasencia is 1386723567. It was assigned to this individual provider in the NPPES registry on November 6, 2006.

Where is Gustavo Plasencia located?

Gustavo Plasencia practices at 9195 Sunset Dr Suite 230, Miami, FL 33173. The listed phone number is (786) 466-6960.

What is Gustavo Plasencia's specialty?

The primary specialty registered for this NPI is Colon & Rectal Surgery with taxonomy code 208C00000X.

Is Gustavo Plasencia enrolled in Medicare?

Yes. Gustavo Plasencia is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Gustavo Plasencia accept?

Health plans from Ambetter Health, Ambetter from Superior HealthPlan, Ambetter of Alabama, AmeriHealth Caritas Next and AvMed and 5 other insurers list Gustavo Plasencia 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.

Is Gustavo Plasencia affiliated with any hospitals?

According to CMS data, Gustavo Plasencia is affiliated with Jackson Health System.

When was this NPI record last updated?

The NPPES record for Gustavo Plasencia was last updated on October 1, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.