NPIMap

Organization Active NPI

Optumcare Florida, LLC

Doing business as DaVita Medical Group

  • Non-Pharmacy Dispensing Site
  • Largo, FL
National Provider Identifier
1033503099
Registry record updated Aug 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
ME86502 Issued in FL
Legal business name
OPTUMCARE FLORIDA, LLC
Doing business as
DaVita Medical Group
Practice address
1345 W Bay Dr
Suite 202
Largo, FL 33770-2282
Phone
(727) 559-0895
NPI assigned
Mar 26, 2015
Last updated
Aug 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2019

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

Authorized official

Name
John G. Liethen
Title
Secretary
Phone
(952) 205-6262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X ME86502 FL Primary

Addresses

Primary practice location

1345 W Bay Dr
Suite 202
Largo, FL 33770-2282

Mailing address

10051 5TH Street N.
St. Petersburg, FL 33702

Other names 1

  • DaVita Medical Group Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1026072Optumcare Florida LLC1345 W Bay Drive Suite 202, Largo, FL 33770Certificate of waiverMay 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Davita Medical Group13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566172800000",
    "number": "1033503099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10051 5TH STREET N.",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "33702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 W BAY DR",
            "address_2": "SUITE 202",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337702282",
            "telephone_number": "727-559-0895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-26",
        "last_updated": "2019-08-19",
        "status": "A",
        "authorized_official_last_name": "LIETHEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "952-205-6262"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ME86502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Largo, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.