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CUSTOM LONGEVITY P.A.
NPI 1306312731
Internal Medicine in Naples, FL

Active since October 24, 2018
4005 GULF SHORE BLVD N APT 402, NAPLES, FL 34103(917) 292-8074 Get Directions Write a Review

NPPES record last updated: October 24, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Custom Longevity P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CUSTOM LONGEVITY P.A. (NPI 1306312731) is a healthcare organization registered as an internal medicine in Naples, Florida and active in the NPI registry since October 2018. The organization lists Svetlana Kogan, Owner, as its authorized official.

NPPES Registry Identity

NPI1306312731
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCUSTOM LONGEVITY P.A.
Location Address4005 GULF SHORE BLVD N APT 402Naples, FL 34103-3433
Mailing Address4005 Gulf Shore Blvd N Apt 402Naples, FL 34103-3433 · (917) 292-8074
Phone(917) 292-8074
Organization SubpartNo
Authorized OfficialSvetlana KoganOwner · (917) 292-8074
Enumeration DateOctober 24, 2018
✔ NPI 1306312731 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
4005 GULF SHORE BLVD N APT 402, Naples, FL 34103
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Custom Longevity P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Custom Longevity P.A., which bills Medicare for the services this clinician delivers.

Clinician (1)

Svetlana Kogan, M.D.
Internal Medicine
NPI 1023054707
4005 GULF SHORE BLVD N APT 402
Naples, FL 34103
(917) 292-8074
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Custom Longevity P.A.'s NPI number?

The NPI number for Custom Longevity P.A. is 1306312731. It was assigned to this organization in the NPPES registry on October 24, 2018.

Where is Custom Longevity P.A. located?

Custom Longevity P.A. is located at 4005 Gulf Shore Blvd N Apt 402, Naples, FL 34103. The listed phone number is (917) 292-8074.

What is Custom Longevity P.A.'s specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Custom Longevity P.A. enrolled in Medicare?

Yes. Custom Longevity P.A. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Custom Longevity P.A.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Custom Longevity P.A.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Custom Longevity P.A. was last updated on October 24, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.