Active NPI
Cornerstone Medical Care of Brandon LLC
- Primary Care Clinic/Center
- Brandon, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- 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
- 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
- Dr. Julio A Enriquez, M.D.
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 267292800 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 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 |
|---|---|---|---|
| 10D1063549 | Cornerstone Medical Care of Brandon, LLC | Certificate of waiver | Jan 16, 2027 |
National Provider Directory
National Provider DirectoryLocations
500 Vonderburg Dr
Ste 102E
Brandon, FL 33511
Phone (813) 681-5658
500 Vonderburg Dr
Ste 101102
Brandon, FL 33511
500 Vonderburg Dr
Ste 102
Brandon, FL 33511
Phone (813) 681-5658
500 Vonderburg Dr
Ste 102
Brandon, FL 33511
Phone (813) 386-2547
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.
-
- Internal Medicine Physician
- Sun City Center, FL
- NPI 1043577109
FL, Single Specialty
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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "267292800",
"state": "FL"
}
],
"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.