Jean Kesnold Mesidor, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

1454 Madison Ave W
Immokalee, FL 34142-2200

Phone

(239) 658-3000

Fax

(239) 658-3199

NPI assigned

Aug 7, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Group practices

Collier Health Services, IncGroup PAC ID 4183521925, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jean.mesidor.1@10865.direct.athenahealth.com

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.

• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Immokalee, FL
  • NPI 1609827211

  FL, Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Sante Plus Medical Center

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1639759475

  FL, Multi-Specialty

  Medicare reassignment NPD
• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Immokalee, FL
  • NPI 1134331416
  Care Compare group NPD (past)
• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Immokalee, FL
  • NPI 1194919993
  Care Compare group NPD (past)
• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Immokalee, FL
  • NPI 1235946716
  Care Compare group NPD (past)
• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Immokalee, FL
  • NPI 1508079245
  Care Compare group NPD (past)
• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Immokalee, FL
  • NPI 1538976006
  Care Compare group NPD (past)
• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Naples, FL
  • NPI 1679124010
  Care Compare group NPD (past)
• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Naples, FL
  • NPI 1790502615
  Care Compare group NPD (past)
• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Naples, FL
  • NPI 1841087525
  Care Compare group NPD (past)
• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Naples, FL
  • NPI 1851505200
  Care Compare group NPD (past)
• Collier Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Immokalee, FL
  • NPI 1902621477
  Care Compare group NPD (past)

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

{
    "created_epoch": "1502064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1891210399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 ATLANTIC AVE FL 2",
            "city": "LYNBROOK",
            "state": "NY",
            "postal_code": "115633046",
            "telephone_number": "516-593-1380",
            "fax_number": "516-977-7451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1454 MADISON AVE W",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "341422200",
            "telephone_number": "239-658-3000",
            "fax_number": "239-658-3199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1755 Heritage Trl Ste 604",
            "address_purpose": "LOCATION",
            "city": "Naples",
            "state": "FL",
            "postal_code": "341127600",
            "country_code": "US",
            "telephone_number": "239-658-3715",
            "fax_number": "239-353-4231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MESIDOR",
        "first_name": "JEAN",
        "middle_name": "KESNOLD",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Irene Maldonado
• Julie Alexandra Mancera Loftin, D.M.D
• Alisha Dawn Mattern, FNP-C
• Giuliana Farias McQuirt, PSY.D.
• Angelique Melendez-Blanch, PSYD
• Sandra Juanita Milan, MD
• Laverne Beal Miller, M.ED
• Serge Mistivar, D.O
• Jennifer L Moes, APRN
• Perla Moran

• All providers in Immokalee, FL
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.