Patrin Suppatkul Kongkaeow, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME128582 Issued in FL

Practice address

636 Del Prado Blvd
Cape Coral, FL 33990-2695

Phone

(239) 424-3123

Fax

(239) 424-4041

NPI assigned

Jun 26, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Cape Coral Hospitalists Inc

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1336209790
  Medicare reassignment NPD
• Lee Health System Inc

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1942058557
  Medicare reassignment NPD
• Lee Memorial Health System

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1992873319
  Medicare reassignment NPD
• Lee Health System Inc

  • Community/Retail Pharmacy
  • Bonita Springs, FL
  • NPI 1699510925
  NPD
• Lee Memorial Health System

  • Federally Qualified Health Center (FQHC)
  • Port Charlotte, FL
  • NPI 1255171765
  NPD
• Lee Memorial Health System

  • Federally Qualified Health Center (FQHC)
  • Fort Myers, FL
  • NPI 1770165920
  NPD

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593129600000",
    "number": "1881034650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13607 PINE VILLA LN",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339121617",
            "telephone_number": "239-424-3123",
            "fax_number": "239-424-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 DEL PRADO BLVD",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339902695",
            "telephone_number": "239-424-3123",
            "fax_number": "239-424-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPPATKUL KONGKAEOW",
        "first_name": "PATRIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-26",
        "last_updated": "2020-06-26",
        "certification_date": "2020-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME128582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019030900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunshine Assisted Living Home Care Facility
• Sunshine Behavior Academy Inc
• Sunshine Community Homes, LLC
• Sunshine Family Doctor LLC
• Sunshine Love Alf, Inc
• Sure Start LLC
• Surgery Centre of SW Florida LLC
• Matthew Sushil, PHARMD
• SW Florida Medical Group LLC
• SW Florida Medical Transport Inc.

• Internal Medicine Physician in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.