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Centerwell Senior Primary Care NV P C

Organization Active NPI Internal Medicine Physician · Miami, FL

NPI 1104449560 · NPPES record last updated Dec 16, 2025

Key facts

NPI
1104449560
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE NV P C
Practice address
6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone
(844) 630-0700
NPI assigned
May 20, 2020
Organization subpart
Yes
Parent organization (as reported)
CENTERWELL SENIOR PRIMARY CARE NV P C

Authorized official

Name
Angie Martinez
Title
Senior Credentialing Professional
Phone
(407) 447-7120

Corporate family (same tax ID) 16

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

Practitioners 58

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

View all 58

National Provider Directory

Tax ID family
Centerwell Senior Primary Care NV P C (17 organizations share this tax ID)
Part of
Centerwell Senior Primary Care NV P C

Locations

2335 E Lake Mead Blvd
North Las Vegas, NV 89030
Phone (702) 577-1910

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes
Interventional Cardiology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RI0011X
General Practice Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208D00000X

Addresses

Primary practice location

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Other names

  • Partners in primary Care (NV) PC Former legal business name
  • CENTERWELL SENIOR PRIMARY CARE (NV) PC Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 16, 2025.

{
    "created_epoch": "1589932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1104449560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "844-630-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE NV P C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERWELL SENIOR PRIMARY CARE NV P C",
        "enumeration_date": "2020-05-20",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Partners in primary Care (NV) PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Partners in primary Care (NV) PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "CENTERWELL SENIOR PRIMARY CARE (NV) PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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