NPIMap

Organization Active NPI

Gastroenterology Consultants of SW FL, PA

  • Gastroenterology Physician
  • Fort Myers, FL
National Provider Identifier
1417099029
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
GASTROENTEROLOGY CONSULTANTS OF SW FL, PA
Practice address
5050 Mason Corbin CT
Fort Myers, FL 33907-4541
Phone
(239) 482-2280
Fax
(239) 482-2281
NPI assigned
Feb 12, 2007
Last updated
Oct 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Authorized official

Name
Dr. Suresh Chavakula, MDNPI 1598719551
Title
Owner
Phone
(239) 482-2280

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU
Anesthesiology Physician 207L00000X ME78992 FL
Gastroenterology Physician 207RG0100X NU Primary

Addresses

Primary practice location

5050 Mason Corbin CT
Fort Myers, FL 33907-4541

Mailing address

5050 Mason Corbin CT
Fort Myers, FL 33907-4541
Phone (239) 482-2280

Other identifiers 1

IdentifierTypeStateIssuer
257130700MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050321000629 FL Part B Supplier - Clinic/Group Practice 6901851153 Receives reassigned benefits from 8 practitioners
Practice locations: Fort Myers, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761091200000",
    "number": "1417099029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 MASON CORBIN CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339074541",
            "telephone_number": "239-482-2280",
            "fax_number": "239-482-2281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 MASON CORBIN CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339074541",
            "telephone_number": "239-482-2280",
            "fax_number": "239-482-2281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY CONSULTANTS OF SW FL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A",
        "authorized_official_last_name": "CHAVAKULA",
        "authorized_official_first_name": "SURESH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-482-2280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME78992",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257130700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; 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.