Active NPI
Nature Coast Primary Care Lab LLC
- Clinical Medical Laboratory
- Crystal River, FL
National Provider Identifier
1114534385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- NATURE COAST PRIMARY CARE LAB LLC
- Practice address
- 7562 W Gulf to Lake Hwy
Crystal River, FL 34429-7840 - Phone
- (352) 436-4328
- Fax
- (352) 260-0960
- NPI assigned
- Sep 30, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Edward R Kop
- Title
- Delegated Official
- Phone
- (352) 362-0627
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary |
Addresses
Primary practice location
7562 W Gulf to Lake Hwy
Crystal River, FL 34429-7840
Mailing address
4918 SW 107TH Loop
Ocala, FL 34476-4723
Phone (352) 362-0627
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210302001160 | FL | Part B Supplier - Clinic/Group Practice | 4284040163 |
Receives reassigned benefits from 10 practitioners Practice locations: Crystal River, FL |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2044110 | Nature Coast Primary Care PLLC | Certificate of waiver | Jul 16, 2026 |
| 10D2203512 | Nature Coast Primary Care Lab LLC | Accreditation | Nov 2, 2027 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 11
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Crystal River, FL
- NPI 1740596451
FL
-
- Internal Medicine Physician
- Crystal River, FL
- NPI 1558380139
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601424000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1604534400000",
"number": "1114534385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4918 SW 107TH LOOP",
"city": "OCALA",
"state": "FL",
"postal_code": "344764723",
"telephone_number": "352-362-0627",
"fax_number": "877-573-9013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7562 W GULF TO LAKE HWY",
"city": "CRYSTAL RIVER",
"state": "FL",
"postal_code": "344297840",
"telephone_number": "352-436-4328",
"fax_number": "352-260-0960"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NATURE COAST PRIMARY CARE LAB LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-09-30",
"last_updated": "2020-11-05",
"certification_date": "2020-11-05",
"status": "A",
"authorized_official_last_name": "KOP",
"authorized_official_first_name": "EDWARD",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "DELEGATED OFFICIAL",
"authorized_official_telephone_number": "352-362-0627",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal River, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.