NPIMap

Organization Active NPI

Gesiotto,Henricks,Kordonowy,and Simmons,MDS,PA

Doing business as Internal Medicine of Southwest Florida

  • Internal Medicine Physician
  • Fort Myers, FL
National Provider Identifier
1700803590
Registry record updated Mar 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GESIOTTO,HENRICKS,KORDONOWY,AND SIMMONS,MDS,PA
Doing business as
Internal Medicine of Southwest Florida
Practice address
6311 S Pointe Blvd
Fort Myers, FL 33919-4901
Phone
(239) 275-0040
Fax
(239) 275-7997
NPI assigned
Jul 16, 2006
Last updated
Mar 4, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2010

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

Authorized official

Name
Linda Hiscock, C.M.M.
Title
Practice Administrator
Phone
(239) 275-7997

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

6311 S Pointe Blvd
Fort Myers, FL 33919-4901

Mailing address

6311 S Pointe Blvd
Fort Myers, FL 33919-4901
Phone (239) 275-0040

Other identifiers 1

IdentifierTypeStateIssuer
K0590OtherFLUNSPECIFIED

Other names 1

  • Internal Medicine of Southwest Florida Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100304000424 FL Part B Supplier - Clinic/Group Practice 8123163912 Receives reassigned benefits from 7 practitioners
Practice locations: Fort Myers, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0966750Internal Medicine of Southwest Florida6311 S Pointe Blvd, Fort Myers, FL 33919AccreditationApr 13, 2028

National Provider Directory

National Provider Directory

Locations

3033 Winkler Ave
Unit 140
Fort Myers, FL 33916
Phone (239) 275-0040

6311 S Pointe Blvd
Ste 500
Fort Myers, FL 33919

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267660800000",
    "number": "1700803590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6311 S POINTE BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194901",
            "telephone_number": "239-275-0040",
            "fax_number": "239-275-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6311 S POINTE BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194901",
            "telephone_number": "239-275-0040",
            "fax_number": "239-275-7997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GESIOTTO,HENRICKS,KORDONOWY,AND SIMMONS,MDS,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2010-03-04",
        "status": "A",
        "authorized_official_last_name": "HISCOCK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "239-275-7997",
        "authorized_official_credential": "C.M.M."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNSPECIFIED",
            "identifier": "K0590",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Internal Medicine of Southwest Florida",
            "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 Mar 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.