Mahalath Sabina Pongo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9114902 Issued in FL

Practice address

8380 Riverwalk Park Blvd Ste 100
Fort Myers, FL 33919-8758

Phone

(239) 343-9960

Fax

(239) 343-2997

NPI assigned

Sep 21, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kagan Jugan and Associates PAGroup PAC ID 5799676193, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hendry Regional Medical Center Hospital, Clewiston, FL, CCN 101309
• Lee Memorial Hospital Hospital, Fort Myers, FL, CCN 100012

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpongo292148@direct.leememorial.org

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.

• Kagan Jugan & Associates PA

  • Orthopaedic Surgery Physician
  • Fort Myers, FL
  • NPI 1861450827
  Medicare reassignment Care Compare group
• Coastal Care Health System, Inc.

  • Urgent Care Clinic/Center
  • Fort Myers, FL
  • NPI 1851950661
  Medicare reassignment
• Lee Memorial Health System

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1992873319
  Medicare reassignment
• Kagan, Jugan & Associates

  • Orthopaedic Surgery Physician
  • Lehigh Acres, FL
  • NPI 1912232299
  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

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

• Hendry County Hospital Authority

  • Critical Access Hospital
  • Clewiston, FL
  • NPI 1215960315
  Care Compare affiliation
• Lee Health System Inc

  • General Acute Care Hospital
  • Fort Myers, FL
  • NPI 1427806025
  Care Compare affiliation

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

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1881365872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-343-9960",
            "fax_number": "239-343-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8380 RIVERWALK PARK BLVD STE 100",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339198758",
            "telephone_number": "239-343-9960",
            "fax_number": "239-343-2997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONGO",
        "first_name": "MAHALATH",
        "middle_name": "SABINA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-21",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9114902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113843200",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpongo292148@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "Lee Memorial Health System",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2776 Cleveland Ave",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339015864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jacqueline May Pollet, CRNA
• Kayla Ponce de Leon, RBT
• Helayne Caridad Ponce, PTA
• Christopher Hawthorne Ponder, M.D.
• Jacob Ponder
• Pooja Shastri, Psy.D., P.a.
• Kadyn Pool
• Poonam Poonam, M.D.
• Julie C Pope, CRNA
• Angela Popovich

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; 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.