Centerwell Senior Primary Care (NV) PC
Organization Active NPI Internal Medicine Physician · Las Vegas, NV
NPI 1083237465 · NPPES record last updated Jul 3, 2024
Key facts
- NPI
- 1083237465
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CENTERWELL SENIOR PRIMARY CARE (NV) PC
- Practice address
- 1766 E Charleston Blvd
Las Vegas, NV 89104-1945 - Phone
- (702) 843-2440
- Fax
- (833) 749-0349
- NPI assigned
- May 20, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTERWELL SENIOR PRIMARY CARE (NV) PC
Authorized official
- Name
- Angie Martinez
- Title
- Senior Credentialing Professional
- Phone
- (407) 447-7120
Other NPIs on the same Medicare enrollment 23
Practitioners 60
-
Alexander Ramo Abesamis, APRN-RX
-
Kristi A Asante, MD
-
Heather Ballantyne, APRN, FNP-C
-
Thomas M Bergren, DO
-
Pauline Lee Chao, MD
-
Michael Chau, FNP-BC
-
Jesse N. Connors, PA-C
-
Joyce Carlos Damiano, APRN, MSN, FNP-BC
-
Carolyn A. Dechaine, PA - C
-
Gregory Desimone, DO
-
Kahrenanne Alegre Dy-Patacsil, APRN, NP-C
-
Ramin Etebar, MD LTD
-
Greg E Fihn, DO
-
Sonia Garcia-Jayne, D.O.
-
Flor Elena Guerrero, APRN
-
Oussama Hajal, PA
-
Sarah Jane Hanshaw, FNP-BC
-
Karyn Harries, DO
-
Heather Elisabeth Harvey, MPA, MSN, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 29D2192479 | Centerwell Senior Primary Care - Fremont Street | Certificate of waiver | Sep 9, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200901001111 | NV | Part B Supplier - Clinic/Group Practice | 5092132340 |
Receives reassigned benefits from 97 practitioners 24 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Las Vegas, NV; North Las Vegas, NV; Henderson, NV |
National Provider Directory
- Part of
- Centerwell Senior Primary Care NV P C
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| Interventional Cardiology Physician |
207RI0011X | |||
| General Practice Physician |
208D00000X |
Addresses
Primary practice location
1766 E Charleston Blvd
Las Vegas, NV 89104-1945
Mailing address
6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 250009773 | Medicaid | NV |
Other names
- CenterWell Senior Primary Care -Fremont Street
- Partners in Primary Care-Fremont Street
- Partners in Primary Care NV PC
Other providers in Las Vegas, NV
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- Centerwell Senior Primary Care (NV) PC
- Centerwell Senior Primary Care (NV) PC
- Centerwell Senior Primary Care (NV) PC
- Centerwell Senior Primary Care (NV) PC
- Centerwell Senior Primary Care (NV) PC
- Centerwell Senior Primary Care (NV) PC
- Centerwell Senior Primary Care (NV) PC
All providers in Las Vegas, NV · Internal Medicine Physician in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.