Organization Active NPI

Cruz Medical and Wellness Services LLC

  • Family Medicine Physician
  • Clermont, FL
National Provider Identifier
1114776176
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CRUZ MEDICAL AND WELLNESS SERVICES LLC
Practice address
255 Citrus Tower Blvd Ste 202
Clermont, FL 34711-1906
Phone
(352) 432-3289
Fax
(352) 432-3290
NPI assigned
May 14, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Authorized official

Name
Edgar Cruz, MDNPI 1578662581
Title
Owner
Phone
(352) 432-3289

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

255 Citrus Tower Blvd Ste 202
Clermont, FL 34711-1906

Mailing address

255 Citrus Tower Blvd Ste 202
Clermont, FL 34711-1906
Phone (352) 432-3289

Other names 1

  • Cruz Medical and Wellness Services LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240607003557 FL Part B Supplier - Clinic/Group Practice 4284176009 Receives reassigned benefits from 1 practitioner
Practice locations: Clermont, FL

National Provider Directory

National Provider Directory

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": "1715644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1114776176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 CITRUS TOWER BLVD STE 202",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111906",
            "telephone_number": "352-432-3289",
            "fax_number": "352-432-3290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 CITRUS TOWER BLVD STE 202",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111906",
            "telephone_number": "352-432-3289",
            "fax_number": "352-432-3290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRUZ MEDICAL AND WELLNESS SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-14",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-432-3289",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cruz Medical and Wellness Services LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clermont, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.