Individual provider Active NPI

Sady M. Rego, PA-C

  • Physician Assistant
  • Cape Coral, FL
National Provider Identifier
1104892975
Registry record updated Apr 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9101759 Issued in FL
Practice address
2366 Surfside Blvd # C-111
Cape Coral, FL 33991-3180
Phone
(239) 360-2795
Fax
(239) 360-2796
NPI assigned
Feb 23, 2006
Last updated
Apr 20, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9101759 FL Primary

Addresses

Primary practice location

2366 Surfside Blvd # C-111
Cape Coral, FL 33991-3180

Mailing address

15051 S Tamiami TRL Ste 203
Fort Myers, FL 33908-5182
Phone (239) 437-8810

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050331000641 FL Practitioner - Physician Assistant 3072560242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aqua Dermatology of Florida, PAGroup PAC ID 1153390414, 184 clinicians

Practice addresses (Care Compare)

1015 Crosspointe Dr
Naples, FL 34110-0949
Phone (239) 596-9075

9400 Gladiolus Dr
Suite 320
Fort Myers, FL 33908-9622
Phone (239) 482-7546

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9101759FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Naples Center for Dermatology & Riverchase Dermatology CurrentSince Jan 22, 2018 Accepting new patients

Locations

2366 Surfside Blvd
#C111
Cape Coral, FL 33991
Phone (239) 360-2795

2366 Surfside Blvd
Ste C111
Cape Coral, FL 33991
Phone (239) 360-2795

15051 S Tamiami Trl
Ste 203
Fort Myers, FL 33908
Phone (239) 732-5959

9400 Gladiolus Dr
Ste 320
Fort Myers, FL 33908
Phone (239) 482-7546

1015 Crosspointe Dr
Naples, FL 34110
Phone (239) 596-9075

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: srego@aquadermatology.emadirect.md

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524182400000",
    "number": "1104892975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15051 S TAMIAMI TRL STE 203",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339085182",
            "telephone_number": "239-437-8810",
            "fax_number": "239-313-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2366 SURFSIDE BLVD # C-111",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339913180",
            "telephone_number": "239-360-2795",
            "fax_number": "239-360-2796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REGO",
        "first_name": "SADY",
        "middle_name": "M.",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-23",
        "last_updated": "2018-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Coral, FL

Sources for this page

Verify at the official NPI Registry.