NPIMap

Organization Active NPI

Physicians Primary Care of Southwest Florida, PL

  • Pediatrics Physician
  • Fort Myers, FL
National Provider Identifier
1083696033
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PHYSICIANS PRIMARY CARE OF SOUTHWEST FLORIDA, PL
Practice address
9350 Camelot Dr
Fort Myers, FL 33919-7980
Phone
(239) 481-5437
Fax
(239) 481-0570
NPI assigned
Nov 16, 2005
Last updated
Aug 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Dr. Jon Burdzy, DONPI 1205854510
Title
Managing Physician
Phone
(239) 275-5522

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

9350 Camelot Dr
Fort Myers, FL 33919-7980

Mailing address

12730 New Brittany Blvd Ste 602
Fort Myers, FL 33907-4690
Phone (239) 275-5522

Other identifiers 1

IdentifierTypeStateIssuer
379245506MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031218000177 FL Part B Supplier - Clinic/Group Practice 2769389675 Receives reassigned benefits from 58 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Myers, FL; Lehigh Acres, FL; Estero, FL; Cape Coral, FL

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0293482Physicians Primary Care of Southwest Florida9350 Camelot Dr, Fort Myers, FL 33919AccreditationMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Physicians Primary Care of Southwest Florida PL14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

9350 Camelot Dr
Fort Myers, FL 33919
Phone (239) 481-5437

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1083696033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12730 NEW BRITTANY BLVD STE 602",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339074690",
            "telephone_number": "239-275-5522",
            "fax_number": "239-275-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9350 CAMELOT DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339197980",
            "telephone_number": "239-481-5437",
            "fax_number": "239-481-0570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS PRIMARY CARE OF SOUTHWEST FLORIDA, PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "BURDZY",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "239-275-5522",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "379245506",
            "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 Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.