Individual provider Active NPI

Robert Eliot Kupsaw, M.D.

  • Emergency Medicine Physician
  • Fort Myers, FL
National Provider Identifier
1316004484
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME48214 Issued in FL
Practice address
13778 Plantation Rd
Fort Myers, FL 33912-4301
Phone
(239) 343-0454
Fax
(239) 343-1075
NPI assigned
Jan 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME48214 FL
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician 207PE0005X ME48214 FL
Emergency Medicine Physician 207P00000X ME48214 FL Primary

Addresses

Primary practice location

13778 Plantation Rd
Fort Myers, FL 33912-4301

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-0454

Other identifiers 4

IdentifierTypeStateIssuer
1492OtherFLBLUE CROSS BLUE SHIELD
043729800MedicaidFL
221870OtherFLAMERIGROUP
297506OtherFLAVMED

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rkupsaw5050@Direct.leememorial.org Lee Memorial Health System

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031120000279 FL Practitioner - Emergency MedicinePractitioner - Family Practice 7911801105 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Connecticut School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lee Health System IncGroup PAC ID 9335672146, 1,381 clinicians

Practice addresses (Care Compare)

1138 Country Club Blvd
Cape Coral, FL 33990-3027
Phone (239) 424-1900

13778 Plantation Rd
Fort Myers, FL 33912-4301
Phone (239) 343-0454

9981 S Healthpark Dr
Fort Myers, FL 33908-3618

Hospital & facility affiliations

  • Empath Home Health Home health agency, Fort Myers, FL, CCN 109786
  • Preferred Care Home Health Services Home health agency, Fort Myers, FL, CCN 109423
  • Trilogy Home Healthcare Home health agency, Estero, FL, CCN 108173
  • Millennium Home Care LLC Home health agency, Port Charlotte, FL, CCN 109401
  • Haven Home Health Care Home health agency, Venice, FL, CCN 687116
  • Lee Memorial Hospital Hospital, Fort Myers, FL, CCN 100012
  • Cape Coral Hospital Hospital, Cape Coral, FL, CCN 100244
  • Gulf Coast Medical Center Lee Health Hospital, Fort Myers, FL, CCN 100220

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue89
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Memorial Health System CurrentSince Jan 1, 2003 Accepting new patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Lee Health System Inc Family Medicine CurrentSince Oct 1, 2024 Accepting new patients
Lee Memorial Health System Family Medicine CurrentSince Jan 1, 2003 Accepting new patients
All X Ray Diagnostic Services Corp Past Accepting new patients
Cape Coral Emergency Physicians Emergency Medicine Past Accepting new patients

Locations

1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900

636 Del Prado Blvd S
Cape Coral, FL 33990
Phone (239) 332-5344

1569 Matthew Dr
Fort Myers, FL 33907
Phone (941) 939-1700

13778 Plantation Rd
Fort Myers, FL 33912
Phone (239) 343-0454

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

930 S Main St
Ste C
Labelle, FL 33935
Phone (239) 674-5520

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: rkupsaw5050@direct.leememorial.org

Organizations & group practices 6

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 8

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": "1167609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1316004484",
    "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": "239-343-0454",
            "fax_number": "239-343-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13778 PLANTATION RD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124301",
            "telephone_number": "239-343-0454",
            "fax_number": "239-343-1075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUPSAW",
        "first_name": "ROBERT",
        "middle_name": "ELIOT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-01",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME48214",
            "primary": false
        },
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "FL",
            "license": "ME48214",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME48214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1492",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043729800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "221870",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "297506",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rkupsaw5050@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "Lee Memorial Health System",
            "address_1": "2776 Cleveland Ave",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339015864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.