Individual provider Active NPI

Bradley J Trifilo, PA

  • Physician Assistant
  • Fort Myers, FL
National Provider Identifier
1548810823
Registry record updated May 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112519 Issued in FL
Practice address
12651 Whitehall Dr
Fort Myers, FL 33907-3626
Phone
(239) 424-2030
Fax
(239) 343-4117
NPI assigned
Sep 18, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9112519 FL Primary

Addresses

Primary practice location

12651 Whitehall Dr
Fort Myers, FL 33907-3626

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 424-2030

Other practice location 1

14320 Metropolis Ave Ste 1
Fort Myers, FL 33912-4539
Phone (239) 277-5770

Other identifiers 1

IdentifierTypeStateIssuer
113883900MedicaidFL

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200717001925 FL Practitioner - Physician Assistant 7012331416 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
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

2776 Cleveland Ave
Fort Myers, FL 33901-5864
Phone (239) 343-2000

3227 Lee Blvd
Suite F
Lehigh Acres, FL 33971-1428
Phone (239) 368-0028

3501 Health Ctr Blvd
Estero, FL 34135-8128

501 Del Prado Blvd S
Cape Coral, FL 33990-2618
Phone (239) 343-0765

507 Del Prado Blvd S
Cape Coral, FL 33990-2618
Phone (239) 772-0500

9981 S Healthpark Dr
Fort Myers, FL 33908-3618

Hospital & facility affiliations

  • Cape Coral Hospital Hospital, Cape Coral, FL, CCN 100244
  • Lee Memorial Hospital Hospital, Fort Myers, FL, CCN 100012
  • Gulf Coast Medical Center Lee Health Hospital, Fort Myers, FL, CCN 100220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9112519FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Health System Inc CurrentSince Nov 1, 2024 Accepting new patients
Lee Memorial Health System CurrentSince May 2, 2022 Accepting new patients
Lee Memorial Health System CurrentSince May 2, 2022 Accepting new patients
Lee Health System Inc CurrentSince Nov 1, 2024 Accepting new patients

Locations

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

1569 Matthew Dr
Fort Myers, FL 33907
Phone (941) 939-1700

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

12651 Whitehall Dr
Fort Myers, FL 33907
Phone (239) 424-2030

930 S Main St
Ste C
Labelle, FL 33935
Phone (239) 674-5520

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: btrifilo290653@direct.leememorial.org

Organizations & group practices 5

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 3

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": "1568764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1548810823",
    "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": "239-424-2030",
            "fax_number": "239-343-4117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12651 WHITEHALL DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073626",
            "telephone_number": "239-424-2030",
            "fax_number": "239-343-4117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14320 Metropolis Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339124539",
            "country_code": "US",
            "telephone_number": "239-277-5770",
            "fax_number": "239-985-1911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRIFILO",
        "first_name": "BRADLEY",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-18",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113883900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.