NPIMap

Individual provider Active NPI

Jess Itzikowitz, PA-C

  • Physician Assistant
  • Fort Myers, FL
National Provider Identifier
1255850673
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9110712 Issued in FL
Practice address
13340 Metro Parkway
Suite 200
Fort Myers, FL 33966-4703
Phone
(239) 343-0550
Fax
(239) 343-0559
NPI assigned
Sep 18, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 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 PA9110712 FL Primary

Addresses

Primary practice location

13340 Metro Parkway
Suite 200
Fort Myers, FL 33966-4703

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 424-1449

Other practice location 1

14051 Metropolis Ave
Fort Myers, FL 33912-4330
Phone (239) 343-9270

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
I20171103000467 FL Practitioner - Physician Assistant 1951667146 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oak Grove Physician Services PAGroup PAC ID 8628421526, 65 clinicians
Florida Hospital Medicine Services, LLCGroup PAC ID 7810129640, 263 clinicians

Practice addresses (Care Compare)

160 NW 170 St
North Miami Beach, FL 33169-5521
Phone (305) 651-1100

800 Meadows Rd
Boca Raton, FL 33486-2304
Phone (561) 955-7100

9655 Boynton Beach Blvd
Boynton Beach, FL 33472-4421
Phone (561) 336-7000

Hospital & facility affiliations

National Provider Directory

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

Organizations & group practices 3

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.

Hospital & facility affiliations 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1255850673",
    "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": "239-424-1449",
            "fax_number": "239-424-1423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13340 METRO PARKWAY",
            "address_2": "SUITE 200",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339664703",
            "telephone_number": "239-343-0550",
            "fax_number": "239-343-0559"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14051 Metropolis Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339124330",
            "country_code": "US",
            "telephone_number": "239-343-9270",
            "fax_number": "239-343-9277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ITZIKOWITZ",
        "first_name": "JESS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-18",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9110712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.