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FAMILY TREE MEDICAL GROUP, PA
NPI 1609243989
General Practice in Kissimmee, FL

Active since August 21, 2015
1150 CYPRESS GLEN CIR, KISSIMMEE, FL 34741(407) 483-3200(407) 483-3220 Get Directions Write a Review

NPPES record last updated: October 28, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 19, 2024, Dec 14, 2022, Oct 11, 2022 and 1 more (4 updates tracked since 2019).

About Family Tree Medical Group, Pa NPPES

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

FAMILY TREE MEDICAL GROUP, PA (NPI 1609243989) is a healthcare organization registered as a general practice in Kissimmee, Florida and active in the NPI registry since August 2015. The organization maintains 2 additional practice locations and lists Victor Manuel Pantoja, Ceo, as its authorized official.

NPPES Registry Identity

NPI1609243989
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameFAMILY TREE MEDICAL GROUP, PA
Location Address1150 CYPRESS GLEN CIRKissimmee, FL 34741-7560
Mailing Address1150 Cypress Glen CirKissimmee, FL 34741-7560 · (407) 483-3200 · Fax (407) 483-3220
Phone(407) 483-3200
Fax(407) 483-3220
Organization SubpartNo
Authorized OfficialVictor Manuel PantojaCeo · (407) 483-3200
Enumeration DateAugust 21, 2015
Last NPPES UpdateOctober 28, 20244 updates tracked since enumeration
NPPES CertifiedOctober 28, 2024
✔ NPI 1609243989 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
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 ListedPediatricsTaxonomy 208000000X
1150 CYPRESS GLEN CIR, Kissimmee, FL 34741
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Secondary Practice Locations 2

Location 12201 North Blvd W Ste 2Davenport, FL 33837-8990 · Phone (863) 353-1246 · Fax (863) 419-9547
Location 21050 W Carroll St Ste 2Kissimmee, FL 34741-1268 · Phone (407) 201-3348 · Fax (407) 518-0094

Other Identifiers 2

Medicaid017306100FL
OtherIV484AFL · Medicare

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company), Molina Healthcare and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Family Tree Medical Group, Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Family Tree Medical Group, PA, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Raymond Rodriguez Negron, M.D.
General Practice
NPI 1154874584
1150 CYPRESS GLEN CIR
Kissimmee, FL 34741
(407) 483-3200
✔ PECOS✔ Accepts MedicareSame address
Jean Martinez Cruz, M.D.
General Practice
NPI 1497100952
1222 10TH ST
Saint Cloud, FL 34769
(407) 593-0323
✔ PECOS✔ Accepts Medicare10 mi

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

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 Family Tree Medical Group, PA's NPI number?

The NPI number for Family Tree Medical Group, PA is 1609243989. It was assigned to this organization in the NPPES registry on August 21, 2015.

Where is Family Tree Medical Group, PA located?

Family Tree Medical Group, PA is located at 1150 Cypress Glen Cir, Kissimmee, FL 34741. The listed phone number is (407) 483-3200.

What is Family Tree Medical Group, PA's specialty?

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

Is Family Tree Medical Group, PA enrolled in Medicare?

Yes. Family Tree Medical Group, PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Family Tree Medical Group, PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in General Practice, reassign their Medicare billing to Family Tree Medical Group, PA. A 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 the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Family Tree Medical Group, PA accept?

Health plans from Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company), Molina Healthcare and Wellpoint list Family Tree Medical Group, PA 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 Family Tree Medical Group, PA was last updated on October 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months 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.