NPIMap

Individual provider Active NPI

Edmund G Witkowski, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Venice, FL
National Provider Identifier
1013980713
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
ME0062096 Issued in FL
Practice address
3030 Executive Dr
Venice, FL 34292-2613
Phone
(941) 485-1505
Fax
(941) 485-7495
NPI assigned
Feb 12, 2006
Last updated
Mar 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X ME0062096 FL Primary

Addresses

Primary practice location

3030 Executive Dr
Venice, FL 34292-2613

Mailing address

3030 Executive Dr
Venice, FL 34292-2613
Phone (941) 485-1505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100130000232 FL Practitioner - Orthopedic Surgery 6406929850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Medical College of Wisconsin, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suncoast Orthopaedic Surgery and Sports Medicine, P.a.Group PAC ID 0648296285, 14 clinicians
Empath Therapies LLCGroup PAC ID 5496144529, 108 clinicians

Practice addresses (Care Compare)

3030 Executive Dr
Venice, FL 34292-2613
Phone (941) 485-1505

3600 William Penn Way
Venice, FL 34293-5236
Phone (941) 483-0746

779 Medical Dr
Suite 8
Englewood, FL 34223-3980
Phone (941) 485-1505

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement28
Knee replacement49
Lower limb (leg) arthroscopy (minimally invasive joint repair)16
Upper limb (arm) arthroscopy (minimally invasive joint repair)17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0062096FLMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Suncoast Orthopaedic Surgery & Sports Medicine, P.a. Sports Medicine CurrentSince Nov 18, 2009 Accepting new patients

Locations

779 Medical Dr
Ste 8
Englewood, FL 34223
Phone (941) 371-9773

3030 Executive Dr
Venice, FL 34292
Phone (941) 485-1505

836 Sunset Lake Blvd
Ste 205
Venice, FL 34292
Phone (941) 485-1505

836 Sunset Lake Blvd
Ste 205A
Venice, FL 34292
Phone (941) 485-1505

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1139702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1013980713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 EXECUTIVE DR",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342922613",
            "telephone_number": "941-485-1505",
            "fax_number": "941-485-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 EXECUTIVE DR",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342922613",
            "telephone_number": "941-485-1505",
            "fax_number": "941-485-7495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITKOWSKI",
        "first_name": "EDMUND",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-12",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "FL",
            "license": "ME0062096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, FL

Sources for this page

Verify at the official NPI Registry.