NPIMap

Organization Active NPI

Vijay Ganatra, M.D., P.a.

  • Internal Medicine Physician
  • Fort Myers, FL
National Provider Identifier
1053434258
Registry record updated Jun 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME84201 Issued in FL
Legal business name
VIJAY GANATRA, M.D., P.A.
Practice address
13770 Plantation Rd
Unit 4
Fort Myers, FL 33912-4460
Phone
(239) 561-6263
Fax
(239) 561-6264
NPI assigned
Apr 10, 2007
Last updated
Jun 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2018

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

Authorized official

Name
Dr. Vijay D Ganatra, M.D.NPI 1215992144
Title
President
Phone
(239) 561-6263

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X ME84201 FL Primary

Addresses

Primary practice location

13770 Plantation Rd
Unit 4
Fort Myers, FL 33912-4460

Mailing address

13770 Plantation Rd Ste 4
Fort Myers, FL 33912-4460
Phone (239) 561-6263

Other identifiers 2

IdentifierTypeStateIssuer
263735900MedicaidFL
DQ5776OtherFLRAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100727000941 FL Part B Supplier - Clinic/Group Practice 4880727866 Receives reassigned benefits from 30 practitioners
Practice locations: Cape Coral, FL; For Myers, FL; Fort Myers, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528070400000",
    "number": "1053434258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13770 PLANTATION RD STE 4",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124460",
            "telephone_number": "239-561-6263",
            "fax_number": "239-561-6264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13770 PLANTATION RD",
            "address_2": "UNIT 4",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124460",
            "telephone_number": "239-561-6263",
            "fax_number": "239-561-6264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIJAY GANATRA, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2018-06-04",
        "status": "A",
        "authorized_official_last_name": "GANATRA",
        "authorized_official_first_name": "VIJAY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-561-6263",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME84201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "263735900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "DQ5776",
            "state": "FL"
        }
    ],
    "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 Jun 4, 2018; 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.