NPIMap

Organization Active NPI

Axel Medical Group LLC

  • Pulmonary Disease Physician
  • Fort Myers, FL
National Provider Identifier
1467140228
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
AXEL MEDICAL GROUP LLC
Practice address
6811 Porto Fino Cir
Fort Myers, FL 33912-4354
Phone
(239) 208-6648
Fax
(855) 462-3008
NPI assigned
Apr 28, 2023
Last updated
Sep 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Authorized official

Name
Jessell Llorente
Title
Director of Credentialing
Phone
(239) 223-8129

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

6811 Porto Fino Cir
Fort Myers, FL 33912-4354

Mailing address

4820 Griffin Blvd
Fort Myers, FL 33908-2016
Phone (239) 208-6648

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230623001377 FL Part B Supplier - Clinic/Group Practice 7517325525 Receives reassigned benefits from 11 practitioners
Practice locations: Fort Myers, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1682640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1467140228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4820 GRIFFIN BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339082016",
            "telephone_number": "239-208-6648",
            "fax_number": "855-462-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6811 PORTO FINO CIR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124354",
            "telephone_number": "239-208-6648",
            "fax_number": "855-462-3008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXEL MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-28",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "LLORENTE",
        "authorized_official_first_name": "JESSELL",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "239-223-8129"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Sep 19, 2023; 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.