Individual provider Active NPI

Jerry Matthew Lanza, MD

  • Family Medicine Physician
  • Cape Coral, FL
National Provider Identifier
1710483920
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME149479 Issued in FL
Practice address
1708 Cape Coral Pkwy W Ste 6
Cape Coral, FL 33914-6985
Phone
(239) 540-1495
Fax
(239) 540-1080
NPI assigned
Apr 5, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME149479 FL Primary

Addresses

Primary practice location

1708 Cape Coral Pkwy W Ste 6
Cape Coral, FL 33914-6985

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other practice location 1

2780 Cleveland Ave Ste 709
Fort Myers, FL 33901-5857
Phone (864) 389-9780

Other identifiers 1

IdentifierTypeStateIssuer
110673300MedicaidFL

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
I20210621000783 FL Practitioner - Family Practice 7517367030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

1499 S Brandywine Cir
Fort Myers, FL 33919-6775
Phone (239) 202-0059

1708 Cape Coral Pkwy W
Cape Coral, FL 33914-6985
Phone (239) 540-1495

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME149479FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC Family Medicine CurrentSince May 1, 2022 Accepting new patients
Millennium Physician Group LLC Family Medicine CurrentSince May 1, 2022 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1708 Cape Coral Pkwy W
Ste 6
Cape Coral, FL 33914
Phone (239) 540-1495

2002 Del Prado Blvd S
Ste 100
Cape Coral, FL 33990
Phone (239) 217-4470

1708 Cape Coral Pkwy W
Cape Coral, FL 33914
Phone (239) 333-3333

126 Del Prado Blvd N
Ste 103
Cape Coral, FL 33909
Phone (239) 217-4470

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

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

3434 Hancock Bridge Pkwy
Ste 301
North Ft Myers, FL 33903
Phone 877856377411108

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: jerry.lanza.1@4290.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1710483920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 CAPE CORAL PKWY W STE 6",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339146985",
            "telephone_number": "239-540-1495",
            "fax_number": "239-540-1080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2780 Cleveland Ave Ste 709",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339015857",
            "country_code": "US",
            "telephone_number": "864-389-9780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANZA",
        "first_name": "JERRY",
        "middle_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-05",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME149479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110673300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Coral, FL

Sources for this page

Verify at the official NPI Registry.