Ivan L Mazzorana Jr., MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME00623151 Issued in FL

Practice address

12590 Whitehall Dr Ste 3
Fort Myers, FL 33907-4680

Phone

(239) 939-9090

Fax

(239) 939-2922

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Psychiatry

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Dna Comprehensive Therapy Services LLCGroup PAC ID 2860619632, 446 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ivan.mazzorana.1@13142.direct.athenahealth.com

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.

• Dna Comprehensive Therapy Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Myers, FL
  • NPI 1316363757

  Psychiatry

  Medicare reassignment Care Compare group NPD
• Ivan L Mazzorana Jr MD PA

  • Psychiatry Physician
  • Ft Myers, FL
  • NPI 1790877488
  Medicare reassignment NPD Authorized official
• Bonita Springs Retirement Village, Inc.

  • Skilled Nursing Facility
  • Bonita Springs, FL
  • NPI 1700126802
  NPD

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1669480653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12590 WHITEHALL DR",
            "address_2": "STE 3",
            "city": "FT MYERS",
            "state": "FL",
            "postal_code": "339073620",
            "telephone_number": "239-939-9090",
            "fax_number": "239-939-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12590 WHITEHALL DR STE 3",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339074680",
            "telephone_number": "239-939-9090",
            "fax_number": "239-939-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZORANA",
        "first_name": "IVAN",
        "middle_name": "L",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME00623151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Elizabeth Maysonet
• Cynthia Maza Perez, DO
• Joseph F Mazza Jr., M.D.
• Frank Mazzeo Jr., DDS
• Angelica M Mazzola, PA
• MC RV for Growth LLC
• Padmanie Davie McAnulty, PHARMD
• Kendrick D McArthur, D.O
• David William McBreen, RPH
• Kristina Marie Hutchinson McBride, LPC

• Psychiatry Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.