Individual provider Active NPI

Nancy McGeorge, P.A.-C

  • Physician Assistant
  • Fort Myers, FL
National Provider Identifier
1033341102
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
009696 Issued in NY
Practice address
4771 S Cleveland Ave
Fort Myers, FL 33907-1317
Phone
(239) 343-9800
Fax
(239) 343-9848
NPI assigned
Aug 21, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 009696 NY Primary

Addresses

Primary practice location

4771 S Cleveland Ave
Fort Myers, FL 33907-1317

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-9800

Other practice location 1

255 Lafayette Ave
Suffern, NY 10901-4812
Phone (845) 368-5000

Other identifiers 1

IdentifierTypeStateIssuer
016210200MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nmcgeorge92294@Direct.leememorial.org Lee Memorial Health System

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
009696NYMDNutritionist

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Charity Health System Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: nmcgeorge92294@direct.leememorial.org

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1250812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1033341102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-343-9800",
            "fax_number": "239-343-9848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4771 S CLEVELAND AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071317",
            "telephone_number": "239-343-9800",
            "fax_number": "239-343-9848"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 Lafayette Ave",
            "address_purpose": "LOCATION",
            "city": "Suffern",
            "state": "NY",
            "postal_code": "109014812",
            "country_code": "US",
            "telephone_number": "845-368-5000",
            "fax_number": "845-987-5979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCGEORGE",
        "first_name": "NANCY",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-21",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "009696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016210200",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nmcgeorge92294@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "Lee Memorial Health System",
            "address_1": "2776 Cleveland Ave",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339015864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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 Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.