NPIMap

Individual provider Active NPI

Ndubuisi Christopher Edeoga, MD

  • Infectious Disease Physician
  • Port Charlotte, FL
National Provider Identifier
1497919039
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
ME115682 Issued in FL
Practice address
21205 Olean Blvd
Ste a
Port Charlotte, FL 33952-6756
Phone
(941) 613-2800
Fax
(941) 613-2801
NPI assigned
Jul 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X ME115682 FL Primary

Addresses

Primary practice location

21205 Olean Blvd
Ste a
Port Charlotte, FL 33952-6756

Mailing address

21205 Olean Blvd
Ste a
Port Charlotte, FL 33952-6756
Phone (941) 613-2800

Other identifiers 2

IdentifierTypeStateIssuer
009262800MedicaidFL
ME115682OtherFLLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130730000906 FL Practitioner - Infectious DiseasePractitioner - Internal Medicine 9436325495 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Florida Department of HealthGroup PAC ID 3072424282, shared by 68 NPIs, 126 clinicians
Infectious Diseases Consultants, P.a.Group PAC ID 2860399680, 3 clinicians

Practice addresses (Care Compare)

Punta Gorda, FL 33950
Phone (815) 793-3114

1021 Health Park Dr
Moore Haven, FL 33471-6206
Phone (863) 946-0707

21205 Olean Blvd
Suite a
Port Charlotte, FL 33952-6756
Phone 9416132800210

Hospital & facility affiliations

  • HCA Florida Healthcare at Home Home health agency, PT Charlotte, FL, CCN 108013
  • Amedisys Home Health Home health agency, Port Charlotte, FL, CCN 108270
  • HCA Florida Fawcett Hospital Hospital, Port Charlotte, FL, CCN 100236
  • HCA Florida Englewood Hospital Hospital, Englewood, FL, CCN 100267
  • Adventhealth Port Charlotte Hospital, Port Charlotte, FL, CCN 100077
  • Sarasota Memorial Hospital Hospital, Sarasota, FL, CCN 100087
  • Village Place Healthcare and Rehabilitation Center Nursing home, Port Charlotte, FL, CCN 106072

Merit-based Incentive Payment System (MIPS)

Final score
87.14 of 100Reported as individual
Quality
60
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME115682FLMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Infectious Diseases Consultants, P.a. Infectious Disease CurrentSince Jul 15, 2013 Accepting new patients
Ndubuisi C Edeoga Inc. Infectious Disease CurrentSince Oct 31, 2024 Accepting new patients
Florida Department of Health CurrentSince Jan 21, 2014 Accepting new patients
Florida Department of Health CurrentSince Jun 15, 2021 Accepting new patients
Inpatient Consultants of Missouri Inc Past Accepting new patients
Cogent Healthcare of Illinois, LLC Past Accepting new patients

Locations

1021 Health Park Dr
Moore Haven, FL 33471
Phone (863) 946-0405

21205 Olean Blvd
Ste A
Pt Charlotte, FL 33952
Phone (941) 613-2800

1100 Loveland Blvd
Punta Gorda, FL 33980
Phone (941) 624-7200

25325 Rampart Blvd
Punta Gorda, FL 33983
Phone (941) 347-3155

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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 7

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": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1497919039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21205 OLEAN BLVD",
            "address_2": "STE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526756",
            "telephone_number": "941-613-2800",
            "fax_number": "941-613-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21205 OLEAN BLVD",
            "address_2": "STE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526756",
            "telephone_number": "941-613-2800",
            "fax_number": "941-613-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDEOGA",
        "first_name": "NDUBUISI",
        "middle_name": "CHRISTOPHER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-14",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "FL",
            "license": "ME115682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009262800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "ME115682",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.