Arun K Penukonda, MD, FRCS, PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME0062366 Issued in FL

Practice address

323 Del Prado Blvd. S.
Suite 100
Cape Coral, FL 33990

Phone

(239) 574-4110

Fax

(239) 673-6053

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Physician Assistant

Practice roles

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.

• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880
  Medicare reassignment
• Pulmonary Consultants of SW FL PA

  • Pulmonary Disease Physician
  • Cape Coral, FL
  • NPI 1043228307
  NPD (past)

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1215018627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "239-574-4110",
            "fax_number": "239-574-5897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 DEL PRADO BLVD. S.",
            "address_2": "SUITE 100",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "33990",
            "telephone_number": "239-574-4110",
            "fax_number": "239-673-6053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENUKONDA",
        "first_name": "ARUN",
        "middle_name": "K",
        "credential": "MD, FRCS, PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "ME0062366",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME0062366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370617600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hernando Pena Jr.
• Jennifer E Pena, PT, DPT
• Maydelis De la Caridad Pena
• Matt Jospeh Penano, PHARM.D
• John R Penland, DC
• Sarada Penukonda, M.D.
• Jacob Peplow, PHARM-D
• Zahily Peraza-Higgins, ARNP
• Natalia Perdomo Alvarino
• Brieanna Lee Perdue

• Surgery Physician in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.