NPIMap

Organization Active NPI

Endocrinology Institute of South FL LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Bonita Springs, FL
National Provider Identifier
1366855975
Registry record updated Jul 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
ME113113 Issued in FL
Legal business name
ENDOCRINOLOGY INSTITUTE OF SOUTH FL LLC
Practice address
4061 Bonita Beach Rd
Ste 101
Bonita Springs, FL 34134-4074
Phone
(239) 301-0105
Fax
(239) 301-0110
NPI assigned
Jun 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2014

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

Authorized official

Name
Orlando Fernandez, MDNPI 1811133234
Title
Medical Director
Phone
(239) 301-0105

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X ME113113 FL Primary

Addresses

Primary practice location

4061 Bonita Beach Rd
Ste 101
Bonita Springs, FL 34134-4074

Mailing address

4061 Bonita Beach Rd
Ste 101
Bonita Springs, FL 34134-4074
Phone (239) 301-0105

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140722000518 FL Part B Supplier - Clinic/Group Practice 9436375888 Receives reassigned benefits from 10 practitioners
Practice locations: Bonita Springs, FL; Estero, FL; Fort Myers, FL

National Provider Directory

National Provider Directory

Locations

22904 Lyden Dr
Unit 101
Estero, FL 33928

22904 Lyden Dr
Unit 106
Estero, FL 33928

22904 Lyden Dr
Unit 56
Estero, FL 33928
Phone (239) 301-0105

22904 Lyden Dr
Estero, FL 33928
Phone (239) 494-3951

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1366855975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4061 BONITA BEACH RD",
            "address_2": "STE 101",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341344074",
            "telephone_number": "239-301-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4061 BONITA BEACH RD",
            "address_2": "STE 101",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341344074",
            "telephone_number": "239-301-0105",
            "fax_number": "239-301-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDOCRINOLOGY INSTITUTE OF SOUTH FL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "ORLANDO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "239-301-0105",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "FL",
            "license": "ME113113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonita Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; 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.