Individual provider Active NPI

Rolando Luis Gonzalez, M.D.

  • Child & Adolescent Psychiatry Physician
  • Fort Myers, FL
National Provider Identifier
1386080034
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
ME132284 Issued in FL
Practice address
15901 Bass Rd Ste 108
Fort Myers, FL 33908-3838
Phone
(239) 343-6050
Fax
(239) 343-6051
NPI assigned
May 21, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X ME132284 FL Primary
Psychiatry Physician 2084P0800X 69181-20 WI

Addresses

Primary practice location

15901 Bass Rd Ste 108
Fort Myers, FL 33908-3838

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-6050

Other practice location 1

619 N Segoe Rd
Madison, WI 53705-3112
Phone (000) 000-0000

Other identifiers 1

IdentifierTypeStateIssuer
106301500MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rgonzalez244154@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
I20200713001428 FL Practitioner - Psychiatry 7012265697 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2013
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

15901 Bass Rd
Fort Myers, FL 33908-3838

3501 Health Ctr Blvd
Estero, FL 34135-8133

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Health System Inc CurrentSince Jan 27, 2025 Accepting new patients
Lee Memorial Health System CurrentSince Aug 31, 2020 Accepting new patients
Lee Health System Inc CurrentSince Jan 27, 2025 Accepting new patients
Lee Memorial Health System CurrentSince Aug 31, 2020 Accepting new patients

Locations

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

15901 Bass Rd
Ste 108
Fort Myers, FL 33908
Phone (239) 343-9890

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

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: rgonzalez244154@direct.leememorial.org

Organizations & group practices 4

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 2

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": "1369094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1386080034",
    "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": "239-343-6050",
            "fax_number": "239-343-6051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15901 BASS RD STE 108",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339083838",
            "telephone_number": "239-343-6050",
            "fax_number": "239-343-6051"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "619 N Segoe Rd",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537053112",
            "country_code": "US",
            "telephone_number": "000-000-0000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "ROLANDO",
        "middle_name": "LUIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-21",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME132284",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "69181-20",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106301500",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rgonzalez244154@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.