NPIMap

Individual provider Active NPI

Susan Wakesho Ngondo

  • Family Nurse Practitioner
  • Marco Island, FL
National Provider Identifier
1962088047
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11011868 Issued in FL
Practice address
127 S Bahama Ave
Marco Island, FL 34145-5117
Phone
(239) 601-5452
NPI assigned
Mar 20, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11011868 FL
Family Nurse Practitioner 363LF0000X APRN11011868 FL Primary

Addresses

Primary practice location

127 S Bahama Ave
Marco Island, FL 34145-5117

Mailing address

127 S Bahama Ave
Marco Island, FL 34145-5117
Phone (239) 601-5452

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210420000407 FL Practitioner - Nurse Practitioner 4789092321 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
May accept Medicare assignment
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians
ElitemedcareGroup PAC ID 9830621366, 4 clinicians
Collier Medical, LLCGroup PAC ID 5193963460, 2 clinicians

Practice addresses (Care Compare)

1499 S Brandywine Cir
Fort Myers, FL 33919-6775
Phone (239) 202-0059

2338 Immokalee Rd
Suite 203
Naples, FL 34110-1445
Phone (239) 919-4342

5274 Golden Gate Pkwy
Suite 1
Naples, FL 34116-7641
Phone (239) 455-9919

606 Bald Eagle Dr
Suite 616
Marco Island, FL 34145-2781
Phone (239) 970-8292

Hospital & facility affiliations

  • Preferred Care Home Health Services Home health agency, Fort Myers, FL, CCN 109423
  • Empath Home Health Home health agency, Fort Myers, FL, CCN 109786
  • Navigate Home Health Care Home health agency, Cape Coral, FL, CCN 109046
  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11011868FLMDFamily Medicine Physician
APRN11011868FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Collier Medical, LLC CurrentSince Dec 1, 2025 Accepting new patients
Afya Med Services LLC Family CurrentSince Jan 1, 2024 Accepting new patients
Elitemedcare CurrentSince Dec 20, 2024 Accepting new patients
M & H Med Housecalls, LLC CurrentSince Feb 14, 2022 Accepting new patients
Vera M Robert MD DO PA Family Medicine PastSince Dec 1, 2025 Accepting new patients

Locations

1407 Viscaya Pkwy
Ste 2
Cape Coral, FL 33990
Phone (239) 772-0111

606 Bald Eagle Dr
Ste 616
Marco Island, FL 34145
Phone (239) 601-5452

5274 Golden Gate Pkwy
Ste 1
Naples, FL 34116
Phone (239) 455-9917

2338 Immokalee Rd
Naples, FL 34110
Phone (239) 330-2933

Organizations & group practices 5

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 7

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": "1616198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1962088047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 S BAHAMA AVE",
            "city": "MARCO ISLAND",
            "state": "FL",
            "postal_code": "341455117",
            "telephone_number": "239-601-5452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 S BAHAMA AVE",
            "city": "MARCO ISLAND",
            "state": "FL",
            "postal_code": "341455117",
            "telephone_number": "239-601-5452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGONDO",
        "first_name": "SUSAN",
        "middle_name": "WAKESHO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-20",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "11011868",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11011868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marco Island, FL

Sources for this page

Verify at the official NPI Registry.