NPIMap

Organization Active NPI

Moonlight Anesthesia, P.L.

  • Anesthesiology Physician
  • Fort Myers, FL
National Provider Identifier
1033419791
Registry record updated Oct 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
ME97767 Issued in FL
Legal business name
MOONLIGHT ANESTHESIA, P.L.
Practice address
5238 Mason Corbin CT
Suite 101
Fort Myers, FL 33907-7738
Phone
(239) 489-3166
Fax
(239) 481-3650
NPI assigned
Oct 28, 2010
Last updated
Oct 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2010

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

Authorized official

Name
Rebecca Marano
Title
Administrator
Phone
(239) 489-3166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X ME97767 FL Primary

Addresses

Primary practice location

5238 Mason Corbin CT
Suite 101
Fort Myers, FL 33907-7738

Mailing address

PO Box 07272
Fort Myers, FL 33919-0272
Phone (239) 489-3166

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110309000707 FL Part B Supplier - Clinic/Group Practice 0547442758 Receives reassigned benefits from 33 practitioners
Practice locations: Fort Myers, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288224000000",
    "number": "1033419791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 07272",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339190272",
            "telephone_number": "239-489-3166",
            "fax_number": "239-481-3650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5238 MASON CORBIN CT",
            "address_2": "SUITE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339077738",
            "telephone_number": "239-489-3166",
            "fax_number": "239-481-3650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONLIGHT ANESTHESIA, P.L.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-28",
        "last_updated": "2010-10-28",
        "status": "A",
        "authorized_official_last_name": "MARANO",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "239-489-3166"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME97767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Oct 28, 2010; 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.