Danielle Nicole Jividen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9115006 Issued in FL

Practice address

9981 S Healthpark Dr
Fort Myers, FL 33908-3618

Phone

(239) 343-2052

Fax

(239) 343-5848

NPI assigned

Sep 20, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gastroenterology Associates of Southwest Florida LLCGroup PAC ID 8628960937, 62 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cape Coral Hospital Hospital, Cape Coral, FL, CCN 100244
• Lee Memorial Hospital Hospital, Fort Myers, FL, CCN 100012

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: danielle.jividen@ud.eclinicaldirectplus.com

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

• Gastroenterology Associates of Southwest Florida LLC

  • Internal Medicine Physician
  • Ft Myers, FL
  • NPI 1154304087
  Medicare reassignment Care Compare group
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880
  Medicare reassignment NPD
• Fort Myers Internal Medicine LLC

  • Internal Medicine Physician
  • Ft Myers, FL
  • NPI 1346588621
  Medicare reassignment
• Lee Memorial Health System

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1992873319
  Medicare reassignment
• Lee Memorial Health System

  • Federally Qualified Health Center (FQHC)
  • Port Charlotte, FL
  • NPI 1255171765
  NPD
• Lee Memorial Health System

  • Federally Qualified Health Center (FQHC)
  • Fort Myers, FL
  • NPI 1447099973
  NPD
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Brooksville, FL
  • NPI 1073131702
  NPD

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

• Lee Health System Inc

  • General Acute Care Hospital
  • Fort Myers, FL
  • NPI 1427806025
  Care Compare affiliation
• Lee Health System Inc

  • General Acute Care Hospital
  • Cape Coral, FL
  • NPI 1780429076
  Care Compare affiliation

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1033889175",
    "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": "239-343-2052",
            "fax_number": "239-343-5848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9981 S HEALTHPARK DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339083618",
            "telephone_number": "239-343-2052",
            "fax_number": "239-343-5848"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13861 Plantation Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339124342",
            "country_code": "US",
            "telephone_number": "392-225-1306",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "323 Del Prado Blvd S",
            "address_purpose": "LOCATION",
            "city": "Cape Coral",
            "state": "FL",
            "postal_code": "339901747",
            "country_code": "US",
            "telephone_number": "239-574-3382",
            "fax_number": "239-574-5897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JIVIDEN",
        "first_name": "DANIELLE",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-20",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9115006",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114926700",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "daniaddison@icloud.com",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "13861 Plantation Rd",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339124342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Manuel Alejandro Jimenez, MD
• Mara Jimenez
• Melanie Jimenez, FNP-BC
• Sindia B Jimenez
• Amin Hanoi Jiminian Wilmot, M.D.
• Jm2Go, LLC.
• JMC Med Supply Inc
• JMR Therapy Inc
• Jo Ann Agress, PHD, PLLC
• Rithly Joachim

• Physician Assistant in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.