NPIMap

Organization Active NPI

Irecovery, LLC

  • Addiction Medicine (Family Medicine) Physician
  • Fort Myers, FL
National Provider Identifier
1013580398
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
IRECOVERY, LLC
Practice address
12557 New Brittany Blvd Ste 3V-52
Fort Myers, FL 33907-3651
Phone
(239) 299-0322
Fax
(561) 464-5501
NPI assigned
Jul 23, 2021
Organization subpart
Yes
Parent organization
IRECOVERY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mildred Cintron
Title
Credentialing Specialist
Phone
(561) 235-7683

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X Primary
Addiction Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083A0300X

Addresses

Primary practice location

12557 New Brittany Blvd Ste 3V-52
Fort Myers, FL 33907-3651

Mailing address

5030 Champion Blvd Ste G11-535
Boca Raton, FL 33496-2473
Phone (561) 235-7683

Other identifiers 1

IdentifierTypeStateIssuer
107100604MedicaidFL

Other names 1

  • iRecoveryUSA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200409000862 FL Part B Supplier - Clinic/Group Practice 3476982638 Receives reassigned benefits from 11 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; Orlando, FL; Ocala, FL; Pensacola, FL; Plant City, FL; Sarasota, FL; St Petersburg, FL; Tallahassee, FL…

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Irecovery LLC25 organizations share this tax ID, including this one
Part of
Irecovery LLC

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Locations

12557 New Brittany Blvd
Ste 3V52
Fort Myers, FL 33907
Phone (239) 299-0322

575 S Wickham Rd
Ste F522
Melbourne, FL 32904
Phone (321) 215-4477

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1013580398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5030 CHAMPION BLVD STE G11-535",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334962473",
            "telephone_number": "561-235-7683",
            "fax_number": "561-464-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12557 NEW BRITTANY BLVD STE 3V-52",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073651",
            "telephone_number": "239-299-0322",
            "fax_number": "561-464-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRECOVERY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IRECOVERY, LLC",
        "enumeration_date": "2021-07-23",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A",
        "authorized_official_last_name": "CINTRON",
        "authorized_official_first_name": "MILDRED",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "561-235-7683"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107100604",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "iRecoveryUSA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.