NPIMap

Organization Active NPI

Prestige Outpatient Providers, LLC

  • Internal Medicine Physician
  • Naples, FL
National Provider Identifier
1124599824
Registry record updated Dec 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PRESTIGE OUTPATIENT PROVIDERS, LLC
Practice address
2338 Immokalee Rd # 186
Naples, FL 34110-1445
Phone
(239) 330-2933
NPI assigned
Dec 7, 2018
Last updated
Dec 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2018

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

Authorized official

Name
Oksana Rustamova
Title
Credentialing Specialist
Phone
(646) 517-1257

Specialties & licenses 1

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

Addresses

Primary practice location

2338 Immokalee Rd # 186
Naples, FL 34110-1445

Mailing address

2338 Immokalee Rd # 141
Naples, FL 34110-1445
Phone (239) 330-2933

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200214000593 FL Part B Supplier - Clinic/Group Practice 3870929615 Receives reassigned benefits from 28 practitioners
Practice locations: North Port, FL; Naples, FL; Fort Myers, FL; Estero, FL; Cape Coral, FL

National Provider Directory

National Provider Directory

Locations

6135 Rattlesnake Hammock Rd
#R
Naples, FL 34113
Phone (239) 775-7715

6869 Davis Blvd
Naples, FL 34104
Phone (239) 348-6000

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1544140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545350400000",
    "number": "1124599824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2338 IMMOKALEE RD # 141",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341101445",
            "telephone_number": "239-330-2933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2338 IMMOKALEE RD # 186",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341101445",
            "telephone_number": "239-330-2933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE OUTPATIENT PROVIDERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-07",
        "last_updated": "2018-12-21",
        "status": "A",
        "authorized_official_last_name": "RUSTAMOVA",
        "authorized_official_first_name": "OKSANA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "646-517-1257"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naples, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.