NPIMap

Organization Active NPI

Cornerstone Medical Care of Brandon LLC

  • Primary Care Clinic/Center
  • Brandon, FL
National Provider Identifier
1124038989
Registry record updated Jun 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CORNERSTONE MEDICAL CARE OF BRANDON LLC
Practice address
500 Vonderburg Dr
E Tower Ste 102
Brandon, FL 33511-5964
Phone
(813) 681-5658
Fax
(813) 681-5250
NPI assigned
Aug 8, 2006
Last updated
Jun 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2021

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

Authorized official

Name
Dr. Julio A Enriquez, M.D.NPI 1497765267
Title
Managing Member
Phone
(813) 681-5658

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

500 Vonderburg Dr
E Tower Ste 102
Brandon, FL 33511-5964

Mailing address

500 Vonderburg Dr Ste 102
Brandon, FL 33511-5968
Phone (813) 681-5658

Other practice location 1

4051 Upper Creek Dr Ste 112
Sun City Center, FL 33573-6825
Phone (813) 681-5658

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040405001389 FL Part B Supplier - Clinic/Group Practice 0345233409 Receives reassigned benefits from 17 practitioners
Practice locations: Brandon, FL; Sun City Center, FL

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
10D1063549Cornerstone Medical Care of Brandon, LLC4051 Upper Creek Drive Ste 112, Sun City Center, FL 33573Certificate of waiverJan 16, 2027

National Provider Directory

National Provider Directory

Locations

500 Vonderburg Dr
Ste 102
Brandon, FL 33511
Phone (813) 386-2547

500 Vonderburg Dr
Ste 102
Brandon, FL 33511
Phone (813) 681-5658

4051 Upper Creek Dr
Ste 112
Sun City Center, FL 33573
Phone (813) 681-5658

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623888000000",
    "number": "1124038989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 VONDERBURG DR STE 102",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115968",
            "telephone_number": "813-681-5658",
            "fax_number": "813-681-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 VONDERBURG DR",
            "address_2": "E TOWER STE 102",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115964",
            "telephone_number": "813-681-5658",
            "fax_number": "813-681-5250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4051 Upper Creek Dr Ste 112",
            "address_purpose": "LOCATION",
            "city": "Sun City Center",
            "state": "FL",
            "postal_code": "335736825",
            "country_code": "US",
            "telephone_number": "813-681-5658",
            "fax_number": "813-681-5250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CORNERSTONE MEDICAL CARE OF BRANDON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A",
        "authorized_official_last_name": "ENRIQUEZ",
        "authorized_official_first_name": "JULIO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "813-681-5658",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; 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.

Verify at the official NPI Registry.