NPIMap

Organization Active NPI

Lifestyles Healthcare Group PA

  • Medical Physician Assistant
  • Fort Myers, FL
National Provider Identifier
1609313246
Registry record updated Nov 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Legal business name
LIFESTYLES HEALTHCARE GROUP PA
Practice address
11300 Lindbergh Blvd Ste 110
Fort Myers, FL 33913-8827
Phone
(239) 334-9355
NPI assigned
Jan 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2020

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

Authorized official

Name
Darin W Stokke, DCNPI 1316984875
Title
President
Phone
(239) 334-9355

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X Primary

Addresses

Primary practice location

11300 Lindbergh Blvd Ste 110
Fort Myers, FL 33913-8827

Mailing address

11300 Lindbergh Blvd Ste 110
Fort Myers, FL 33913-8827
Phone (239) 334-9355

Other names 1

  • Lifestyles Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170511001775 FL Part B Supplier - Clinic/Group Practice 1557648979 Receives reassigned benefits from 3 practitioners
Practice locations: Fort Myers, FL

National Provider Directory

National Provider Directory

Locations

11300 Lindbergh Blvd
Fort Myers, FL 33913
Phone (239) 334-9355

11300 Lindbergh Blvd
Ste 110
Fort Myers, FL 33913
Phone (239) 334-9355

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1484870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605830400000",
    "number": "1609313246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11300 LINDBERGH BLVD STE 110",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339138827",
            "telephone_number": "239-334-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11300 LINDBERGH BLVD STE 110",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339138827",
            "telephone_number": "239-334-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLES HEALTHCARE GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-20",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A",
        "authorized_official_last_name": "STOKKE",
        "authorized_official_first_name": "DARIN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-334-9355",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifestyles Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lifestyles Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 20, 2020; 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.