Individual provider Active NPI

Irina F Gershin-Stevens, DO

  • Pediatric Nephrology Physician
  • Port Charlotte, FL
National Provider Identifier
1629094735
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
License
OS10700 Issued in FL
Practice address
22655 Bayshore Rd Ste 110
Port Charlotte, FL 33980-2005
Phone
(941) 235-4900
Fax
(941) 235-4901
NPI assigned
Jul 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nephrology Physician 2080P0210X 225785 NY
Pediatric Nephrology Physician 2080P0210X OS10700 FL Primary

Addresses

Primary practice location

22655 Bayshore Rd Ste 110
Port Charlotte, FL 33980-2005

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-9890

Other practice location 1

16261 Bass Rd Ste 100
Fort Myers, FL 33908-3671
Phone (239) 343-9890

Other practice location 2

15901 Bass Rd Ste 102
Fort Myers, FL 33908-3838
Phone (239) 343-9890

Other identifiers 1

IdentifierTypeStateIssuer
001529200MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address igershinstevens4778@Direct.leememorial.org Lee Memorial Health System

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100215000271 FL Practitioner - Pediatric MedicinePractitioner - Neurology 0840298998 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Neurology
Education
Other, 1983
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)

15901 Bass Rd
Suite 102
Fort Myers, FL 33908-3838
Phone (239) 343-9890

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
225785NYMDPediatric Nephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Memorial Health System Current Accepting new patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Lee Memorial Health System CurrentSince Sep 30, 2009 Accepting new patients

Locations

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

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

15901 Bass Rd
Ste 102
Fort Myers, FL 33908
Phone (239) 343-9890

16261 Bass Rd
Ste 100
Fort Myers, FL 33908
Phone (239) 343-9890

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

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

3361 Pine Ridge Rd
Ste 201
Naples, FL 34109
Phone (239) 254-4270

22655 Bayshore Rd
Ste 110
Punta Gorda, FL 33980
Phone (941) 235-4900

Interoperability endpoints

  • Direct secure messaging: igershinstevens4778@direct.leememorial.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1629094735",
    "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": "239-343-9890",
            "fax_number": "239-343-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22655 BAYSHORE RD STE 110",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339802005",
            "telephone_number": "941-235-4900",
            "fax_number": "941-235-4901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16261 Bass Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339083671",
            "country_code": "US",
            "telephone_number": "239-343-9890",
            "fax_number": "239-343-9898",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15901 Bass Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339083838",
            "country_code": "US",
            "telephone_number": "239-343-9890",
            "fax_number": "239-343-9898",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GERSHIN-STEVENS",
        "first_name": "IRINA",
        "middle_name": "F",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "NY",
            "license": "225785",
            "primary": false
        },
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "FL",
            "license": "OS10700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001529200",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "igershinstevens4778@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "Lee Memorial Health System",
            "address_1": "2776 Cleveland Ave",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339015864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.