Individual provider Active NPI

Maximo Jose Santiago, M.D.

  • Diagnostic Radiology Physician
  • Fort Myers, FL
National Provider Identifier
1760718845
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME 104312 Issued in FL
Practice address
14551 Hope Center Loop Ste 100
Fort Myers, FL 33912-4705
Phone
(239) 936-2316
Fax
(239) 936-3099
NPI assigned
Oct 26, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X ME 104312 FL Primary

Addresses

Primary practice location

14551 Hope Center Loop Ste 100
Fort Myers, FL 33912-4705

Mailing address

3660 Broadway
Fort Myers, FL 33901-8005
Phone (239) 936-2316

Other identifiers 1

IdentifierTypeStateIssuer
ME104312OtherFLFLORIDA LICENCE

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
I20100712000350 FL Practitioner - Diagnostic Radiology 1052443934 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Florida College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Regional Center P aGroup PAC ID 9638151756, 60 clinicians

Practice addresses (Care Compare)

10201 Arcos Ave
Suite 101
Estero, FL 33928-9460
Phone (239) 936-2316

1110 Lee Blvd
Lehigh Acres, FL 33936-4844
Phone (239) 936-2316

1708 Cape Coral Pkwy W
Suite 3
Cape Coral, FL 33914-6985
Phone (239) 936-2316

18300 Murdock Cir
Unit 101
Port Charlotte, FL 33948-1116
Phone (239) 936-2316

1875 Veterans Park Dr
Suite 2101
Naples, FL 34109-0596
Phone (239) 936-2316

2301 Del Prado Blvd S
Suite 420
Cape Coral, FL 33990-4698
Phone (239) 936-2316

3660 Broadway
Fort Myers, FL 33901-8005
Phone (239) 936-2316

3670 Broadway
Fort Myers, FL 33901-8005
Phone (239) 936-2316

6100 Winkler Rd
Suite a
Fort Myers, FL 33919-8126
Phone (239) 936-2316

6140 Winkler Rd
Suite a
Fort Myers, FL 33919-8188
Phone (239) 936-2316

6600 University Pkwy
Suite 102
Lakewood Ranch, FL 34240-9040
Phone (239) 936-2316

700 Goodlette N Rd
Naples, FL 34102-5644
Phone (239) 936-2316

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 104312FLMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Regional Center Professional Services LLC Diagnostic Radiology CurrentSince Apr 1, 2015 Accepting new patients
Radiology Regional Center P a Diagnostic Radiology CurrentSince Jul 15, 2010 Accepting new patients
Radiology Regional Center, PA Diagnostic Radiology PastSince Aug 28, 2021 Accepting new patients
Radiology Regional Center, PA Diagnostic Radiology PastSince Aug 28, 2021 Accepting new patients

Locations

9776 Bonita Beach Rd SE
Bonita Springs, FL 34135
Phone (239) 444-2200

805 Del Prado Blvd S
Cape Coral, FL 33990
Phone (239) 242-8010

1708 Cape Coral Pkwy W
Ste 3
Cape Coral, FL 33914
Phone (239) 541-3800

10201 Arcos Ave
Ste 101
Estero, FL 33928
Phone (239) 444-5800

3660 Broadway
Fort Myers, FL 33901
Phone (239) 424-1449

6140 Winkler Rd
Fort Myers, FL 33919

14551 Hope Center Loop
Ste 100
Fort Myers, FL 33912
Phone (399) 362-3162

3680 Broadway
Fort Myers, FL 33901
Phone (239) 936-0380

6100 Winkler Rd
Fort Myers, FL 33919

13681 Doctors Way
Fort Myers, FL 33912
Phone (239) 343-1000

1110 Lee Blvd
Lehigh Acres, FL 33936
Phone (239) 344-1000

700 Goodlette Rd
Naples, FL 34102
Phone (239) 430-1400

18300 Murdock Cir
Unit 101
Port Charlotte, FL 33948

18300 Murdock Cir
Bldg 15
Port Charlotte, FL 33948
Phone (941) 255-7901

6600 University Pkwy
Ste 102
Sarasota, FL 34240
Phone (941) 378-3231

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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": "1256515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1760718845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 BROADWAY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339018005",
            "telephone_number": "239-936-2316",
            "fax_number": "239-931-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14551 HOPE CENTER LOOP STE 100",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124705",
            "telephone_number": "239-936-2316",
            "fax_number": "239-936-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTIAGO",
        "first_name": "MAXIMO",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-26",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME 104312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA LICENCE",
            "identifier": "ME104312",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.