NPIMap

Individual provider Active NPI

Sumeet Shetty, M.D.

  • Internal Medicine Physician
  • Fort Myers, FL
National Provider Identifier
1245319391
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME91067 Issued in FL
Practice address
3050 Champion Ring Rd
Fort Myers, FL 33905-5599
Phone
(239) 313-2901
Fax
(239) 939-4811
NPI assigned
Nov 2, 2006
Last updated
Jun 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME91067 FL Primary
Rehabilitation Practitioner 225400000X ME91067 FL

Addresses

Primary practice location

3050 Champion Ring Rd
Fort Myers, FL 33905-5599

Mailing address

4820 Griffin Blvd
Fort Myers, FL 33908-2016
Phone (239) 208-6648

Other identifiers 2

IdentifierTypeStateIssuer
270760800MedicaidFL
48938OtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041007000639 FL Practitioner - Internal Medicine 8921067646 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Axel Health LLCGroup PAC ID 2062737885, 11 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

13681 Doctors Way
Fort Myers, FL 33912-4300
Phone (239) 208-6648

1499 S Brandywine Cir
Fort Myers, FL 33919-6775
Phone (239) 202-0059

1730 NE Pine Island Rd
Cape Coral, FL 33909-1734
Phone (239) 208-6648

3050 Champion Ring Rd
Fort Myers, FL 33905-5599
Phone (239) 208-6648

3501 Hancock Bridge Pkwy
Fort Myers, FL 33903-7126
Phone (239) 208-6648

4820 Griffin Blvd
Fort Myers, FL 33908-2016

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME91067FLMDRehabilitation Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Axel Medical Group LLC CurrentSince Apr 10, 2023 Accepting new patients
Axel Health Primary Care LLC Internal Medicine CurrentSince Mar 24, 2021 Accepting new patients
Inpatient Specialists of Southwest Internal Medicine Past Accepting new patients
Axel Podiatry Services LLC PastSince Oct 9, 2016 Accepting new patients
Cogent Healthcare of Fort Myers, LLC Internal Medicine Past Accepting new patients

Locations

14192 Metropolis Ave
Fort Myers, FL 33912
Phone (239) 244-9560

6811 Porto Fino Cir
Fort Myers, FL 33912
Phone (239) 225-1306

Organizations & group practices 7

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1245319391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4820 GRIFFIN BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339082016",
            "telephone_number": "239-208-6648",
            "fax_number": "855-462-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 CHAMPION RING RD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339055599",
            "telephone_number": "239-313-2901",
            "fax_number": "239-939-4811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHETTY",
        "first_name": "SUMEET",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME91067",
            "primary": true
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "FL",
            "license": "ME91067",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270760800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "48938",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.