NPIMap

Organization Active NPI

Bay Area Direct Client Care LLC

  • In Home Supportive Care Agency
  • Brandon, FL
National Provider Identifier
1003584301
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
BAY AREA DIRECT CLIENT CARE LLC
Practice address
110 Lithia Pinecrest Rd Ste B
Brandon, FL 33511-5300
Phone
(813) 679-5122
Fax
(564) 524-5855
NPI assigned
Sep 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

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

Authorized official

Name
Deshae Martin, APRNNPI 1861945719
Title
Administrative Director
Phone
(813) 679-5122

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Nursing Care Agency 251J00000X
In Home Supportive Care Agency 253Z00000X Primary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X

Addresses

Primary practice location

110 Lithia Pinecrest Rd Ste B
Brandon, FL 33511-5300

Mailing address

2105 Roanoke Springs Dr
Ruskin, FL 33570-6312
Phone (813) 679-5122

Other identifiers 1

IdentifierTypeStateIssuer
112087100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210225003406 FL Part A Provider - Home Health Agency 2062768724 1 other NPI on this enrollment
Practice locations: Brandon, FL

Home health agency certification: CCN 687243

Legal name
BAY AREA DIRECT CLIENT CARE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 9, 2023
Last certification
Dec 21, 2022
Organization structure
LLCProprietary
Incorporated
Sep 26, 2007 in FL
Enrollment address
110 Lithia Pinecrest Rd
Ste B
Brandon, FL 33511-5300
HHA Branch

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Bay Area Direct Client Care LLCCCN 687243
Ownership
-
Certified
Jan 9, 2023
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Bay Area Direct Client Care5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Bay Area Direct Client Care LLC Organization, Ruskin, FL LLC Operational/Managerial Control Sep 26, 2017 100%
Deshae B Martin Individual 5% Or Greater Direct Ownership InterestOwner Sep 26, 2017 100%
Corporate DirectorOwner Sep 26, 2017 100%
W-2 Managing EmployeeOwner Sep 26, 2017 100%
Operational/Managerial ControlOwner Sep 26, 2017 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642032000000",
    "number": "1003584301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 ROANOKE SPRINGS DR",
            "city": "RUSKIN",
            "state": "FL",
            "postal_code": "335706312",
            "telephone_number": "813-679-5122",
            "fax_number": "564-524-5855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LITHIA PINECREST RD STE B",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115300",
            "telephone_number": "813-679-5122",
            "fax_number": "564-524-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA DIRECT CLIENT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-01",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "DESHAE",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "813-679-5122",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112087100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.