Active NPI
Magdan LLC
- Clinic/Center
- Fort Myers, FL
National Provider Identifier
1619755501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- MAGDAN LLC
- Practice address
- 9405 Cypress Lake Dr Ste 2
Fort Myers, FL 33919-0909 - Phone
- (239) 372-6141
- Fax
- (239) 936-3391
- NPI assigned
- Sep 20, 2023
- Last updated
- Sep 26, 2023
- Organization subpart
- Yes
- Parent organization
- MAGDAN LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Edna Muchugu
- Title
- Executive Director
- Phone
- (239) 372-6141
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | NU | Primary |
Addresses
Primary practice location
9405 Cypress Lake Dr Ste 2
Fort Myers, FL 33919-0909
Mailing address
9405 Cypress Lake Dr Ste 2
Fort Myers, FL 33919-0909
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230831000091 | FL | Part B Supplier - Clinic/Group Practice | 1052774528 |
Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fort Myers, FL |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Sprout Recovery
- Adult Mental Health Clinic/Center
- Fort Myers, FL
- NPI 1609501428
O20230831000091
National Provider Directory
National Provider Directory- Part of
- Magdan LLC
Practitioners & affiliated clinicians
Practitioners 4
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.
-
- Psychiatry Physician
- Jacksonville Beach, FL
- NPI 1750599833
-
- Clinical Social Worker
- Fort Myers, FL
- NPI 1538920509
-
- Psychiatric/Mental Health Nurse Practitioner
- Copiague, NY
- NPI 1477595114
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695168000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695686400000",
"number": "1619755501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9405 CYPRESS LAKE DR STE 2",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339190909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9405 CYPRESS LAKE DR STE 2",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339190909",
"telephone_number": "239-372-6141",
"fax_number": "239-936-3391"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAGDAN LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MAGDAN LLC",
"enumeration_date": "2023-09-20",
"last_updated": "2023-09-26",
"certification_date": "2023-09-26",
"status": "A",
"authorized_official_last_name": "MUCHUGU",
"authorized_official_first_name": "EDNA",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "239-372-6141"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "NU",
"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 26, 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.