Individual provider Active NPI

Viraine S Weerasooriya, MD

  • Pediatric Gastroenterology Physician
  • Port Charlotte, FL
National Provider Identifier
1093733990
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
2018027030 Issued in MO
Practice address
22655 Bayshore Rd Ste 110
Port Charlotte, FL 33980-2005
Phone
(941) 235-4900
Fax
(941) 235-4901
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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 2018027030 MO
Pediatric Gastroenterology Physician 2080P0206X 2018027030 MO Primary

Addresses

Primary practice location

22655 Bayshore Rd Ste 110
Port Charlotte, FL 33980-2005

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-6050

Other practice location 1

1 Childrens Pl
Ste C
Saint Louis, MO 63110-1002
Phone (314) 454-6173

Other practice location 2

16230 Summerlin Rd Ste 215
Fort Myers, FL 33908-5769
Phone (239) 343-6050

Other identifiers 1

IdentifierTypeStateIssuer
275446100MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vweerasooriya7025@Direct.leememorial.org Lee Memorial Health System

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20101028000476 FL Practitioner - GastroenterologyPractitioner - Pediatric Medicine 7214121888 Reassigns benefits to 2 organizations
I20180910002591 MO Practitioner - GastroenterologyPractitioner - Pediatric Medicine 7214121888 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2018027030MOMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Memorial Health System Pediatrics CurrentSince Aug 3, 2020 Accepting new patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Washington University CurrentSince Aug 1, 2018 Accepting new patients
Lee Memorial Health System CurrentSince Aug 3, 2020 Accepting new patients
Lee Health System Inc Pediatrics CurrentSince Oct 1, 2024 Accepting new patients
Washington University CurrentSince Aug 1, 2018 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

16230 Summerlin Rd
Ste 213
Fort Myers, FL 33908
Phone (239) 343-7450

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

22655 Bayshore Rd
Ste 110
Punta Gorda, FL 33980
Phone (941) 235-4900

1 Childrens Pl
#8116
Saint Louis, MO 63110
Phone (314) 454-6095

1 Childrens Pl
Ste C
Saint Louis, MO 63110
Phone (314) 454-2104

1 Childrens Pl
#8328
Saint Louis, MO 63110

Interoperability endpoints

  • Direct secure messaging: vweerasooriya7025@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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1093733990",
    "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": "239-343-6050",
            "fax_number": "239-343-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22655 BAYSHORE RD STE 110",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339802005",
            "telephone_number": "941-235-4900",
            "fax_number": "941-235-4901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Childrens Pl",
            "address_2": "Ste C",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101002",
            "country_code": "US",
            "telephone_number": "314-454-6173",
            "fax_number": "314-454-2412",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16230 Summerlin Rd Ste 215",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339085769",
            "country_code": "US",
            "telephone_number": "239-343-6050",
            "fax_number": "239-343-7455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEERASOORIYA",
        "first_name": "VIRAINE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2018027030",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "MO",
            "license": "2018027030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275446100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vweerasooriya7025@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 Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.