NPIMap

Organization Active NPI

Pain Management Consultants of Southwest Florida, PL

  • Pain Medicine (Anesthesiology) Physician
  • Fort Myers, FL
National Provider Identifier
1649284928
Registry record updated Apr 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
PAIN MANAGEMENT CONSULTANTS OF SOUTHWEST FLORIDA, PL
Practice address
7964 Summerlin Lakes Dr
Fort Myers, FL 33907-1816
Phone
(239) 333-1177
Fax
(239) 333-1169
NPI assigned
Jul 29, 2006
Last updated
Apr 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2019

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

Authorized official

Name
Dr. Eugene D Mahaney, MDNPI 1619978236
Title
Manager
Phone
(239) 333-1177

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
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

7964 Summerlin Lakes Dr
Fort Myers, FL 33907-1816

Mailing address

PO Box 7440
Fort Myers, FL 33911-7440
Phone (239) 333-1177

Other practice location 1

1031 SE 9th Pl Unit 5
Cape Coral, FL 33990-3003
Phone (239) 333-1177

Other practice location 2

9400 Bonita Beach Rd SE Ste 101
Bonita Springs, FL 34135-4520
Phone (239) 333-1177

Other identifiers 4

IdentifierTypeStateIssuer
273924100MedicaidFL
611443800OtherDOL WORKERS COMPENSATION
94990OtherFLBC BS FLORIDA GROUP PROV
DD8974OtherFLRAILROAD MEDICARE PROV #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051031000836 FL Part B Supplier - Clinic/Group Practice 1052338878 Receives reassigned benefits from 9 practitioners
Practice locations: Bonita Springs, FL; Cape Coral, FL; Fort Myers, FL

National Provider Directory

National Provider Directory

Locations

9400 Bonita Beach Rd SE
Ste 101
Bonita Springs, FL 34135
Phone (239) 333-1177

23 Barkley Cir
Fort Myers, FL 33907
Phone (239) 333-1177

2112 Harrisburg Pike
Ste 202
Lancaster, PA 17601
Phone (717) 544-3500

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556150400000",
    "number": "1649284928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7440",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339117440",
            "telephone_number": "239-333-1177",
            "fax_number": "239-939-4733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7964 SUMMERLIN LAKES DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071816",
            "telephone_number": "239-333-1177",
            "fax_number": "239-333-1169"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1031 SE 9th Pl Unit 5",
            "address_purpose": "LOCATION",
            "city": "Cape Coral",
            "state": "FL",
            "postal_code": "339903003",
            "country_code": "US",
            "telephone_number": "239-333-1177",
            "fax_number": "239-333-1169",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9400 Bonita Beach Rd SE Ste 101",
            "address_purpose": "LOCATION",
            "city": "Bonita Springs",
            "state": "FL",
            "postal_code": "341354520",
            "country_code": "US",
            "telephone_number": "239-333-1177",
            "fax_number": "239-333-1169",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PAIN MANAGEMENT CONSULTANTS OF SOUTHWEST FLORIDA, PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2019-04-25",
        "status": "A",
        "authorized_official_last_name": "MAHANEY",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "239-333-1177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273924100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL WORKERS COMPENSATION",
            "identifier": "611443800",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS FLORIDA GROUP PROV",
            "identifier": "94990",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PROV #",
            "identifier": "DD8974",
            "state": "FL"
        }
    ],
    "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 Apr 25, 2019; 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.