Individual provider Active NPI

Patricia Carolina Subnaik, D.O.

  • Pediatric Gastroenterology Physician
  • Fort Myers, FL
National Provider Identifier
1093081986
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
OS16079 Issued in FL
Practice address
15901 Bass Rd Ste 102
Fort Myers, FL 33908
Phone
(239) 343-9890
Fax
(239) 343-9898
NPI assigned
Mar 26, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 03869 KY
Pediatric Gastroenterology Physician 2080P0206X OS16079 FL Primary

Addresses

Primary practice location

15901 Bass Rd Ste 102
Fort Myers, FL 33908

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-9890

Other practice location 1

86 W Underwood St
Orlando, FL 32806-1110
Phone (407) 649-6876

Other practice location 2

86 W Underwood St
Orlando, FL 32806-1110
Phone (407) 649-6876

Other identifiers 1

IdentifierTypeStateIssuer
103021200MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address psubnaik178462@Direct.leememorial.org Lee Memorial Health System

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190614000504 FL Practitioner - Pediatric Medicine 1951613694 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
03869KYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Memorial Health System CurrentSince Jul 15, 2019 Accepting new patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Lee Memorial Health System Pediatrics CurrentSince Jul 15, 2019 Accepting new patients
Lee Health System Inc Pediatrics CurrentSince Oct 1, 2024 Accepting new patients
Orlando Health Medical Group Inc Past Accepting new patients
Orlando Health Medical Group Inc Pediatrics Past Accepting new patients

Locations

1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

16230 Summerlin Rd
Ste 215
Fort Myers, FL 33908
Phone (239) 343-7474

15901 Bass Rd
Ste 102
Fort Myers, FL 33908
Phone (239) 343-9890

930 S Main St
Ste C
Labelle, FL 33935
Phone (239) 674-5520

3361 Pine Ridge Rd
Ste 201
Naples, FL 34109
Phone (239) 254-4270

Interoperability endpoints

  • Direct secure messaging: psubnaik178462@direct.leememorial.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1093081986",
    "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": "239-343-9890",
            "fax_number": "239-343-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15901 BASS RD STE 102",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33908",
            "telephone_number": "239-343-9890",
            "fax_number": "239-343-9898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "86 W Underwood St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328061110",
            "country_code": "US",
            "telephone_number": "407-649-6876",
            "fax_number": "407-872-0544",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "86 W Underwood St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328061110",
            "country_code": "US",
            "telephone_number": "407-649-6876",
            "fax_number": "407-872-0544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUBNAIK",
        "first_name": "PATRICIA",
        "middle_name": "CAROLINA",
        "name_prefix": "Miss",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-26",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "03869",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "FL",
            "license": "OS16079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103021200",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "psubnaik178462@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

Verify at the official NPI Registry.