Individual provider Active NPI

Keri Lyn Mason, D.O.

  • Internal Medicine Physician
  • Fort Myers, FL
National Provider Identifier
1932293883
Registry record updated Jun 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS10037 Issued in FL
Practice address
13607 Pine Villa LN
Fort Myers, FL 33912-1617
Phone
(239) 210-0132
Fax
(239) 210-0134
NPI assigned
Oct 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 056151 GA
Internal Medicine Physician 207R00000X OS10037 FL Primary

Addresses

Primary practice location

13607 Pine Villa LN
Fort Myers, FL 33912-1617

Mailing address

13607 Pine Villa LN
Fort Myers, FL 33912-1617
Phone (239) 210-0132

Other identifiers 1

IdentifierTypeStateIssuer
14CS1OtherFLBCBS OF FL

Other names 1

  • Keri Lyn Mullen Former name

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
I20110617000193 FL Practitioner - Internal Medicine 0244418481 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lee Health System IncGroup PAC ID 9335672146, 1,381 clinicians

Practice addresses (Care Compare)

1138 Country Club Blvd
Cape Coral, FL 33990-3027
Phone (239) 424-1900

2776 Cleveland Ave
Fort Myers, FL 33901-5864
Phone (239) 343-2000

Hospital & facility affiliations

  • Cape Coral Hospital Hospital, Cape Coral, FL, CCN 100244
  • Lee Memorial Hospital Hospital, Fort Myers, FL, CCN 100012

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
056151GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Lee Memorial Health System CurrentSince Mar 1, 2022 Accepting new patients
Lee Memorial Health System Internal Medicine Current Accepting new patients
Lee Health System Inc Internal Medicine CurrentSince Oct 1, 2024 Accepting new patients
Lee Memorial Health System CurrentSince Mar 1, 2022 Accepting new patients
Cape Coral Hospitalists Inc Internal Medicine CurrentSince May 4, 2011 Accepting new patients

Locations

1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900

636 Del Prado Blvd S
Cape Coral, FL 33990
Phone (239) 332-5344

1569 Matthew Dr
Fort Myers, FL 33907
Phone (941) 939-1700

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

9981 S Healthpark Dr
Fort Myers, FL 33908
Phone (239) 332-5344

930 S Main St
Ste C
Labelle, FL 33935
Phone (239) 674-5520

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: kmason5636@direct.leememorial.org

Organizations & group practices 6

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 2

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308268800000",
    "number": "1932293883",
    "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": "239-210-0132",
            "fax_number": "239-210-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13607 PINE VILLA LN",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339121617",
            "telephone_number": "239-210-0132",
            "fax_number": "239-210-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASON",
        "first_name": "KERI",
        "middle_name": "LYN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2011-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "056151",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS10037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "14CS1",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERI",
            "last_name": "MULLEN",
            "middle_name": "LYN",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.