Organization Active NPI

Bay Area Mobile Clinic LLC

  • Clinic/Center
  • Dade City, FL
National Provider Identifier
1235637398
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
BAY AREA MOBILE CLINIC LLC
Practice address
15000 Citrus Country Dr # 414
Dade City, FL 33523-6014
Phone
(813) 924-8911
NPI assigned
Jan 24, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Authorized official

Name
Junise BelizaireNPI 1518306810
Title
Owner
Phone
(813) 924-8911

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
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

15000 Citrus Country Dr # 414
Dade City, FL 33523-6014

Mailing address

15000 Citrus Country Dr # 414
Dade City, FL 33523-6014

Other practice location 1

7715 Bulls Head Dr
Wesley Chapel, FL 33545-7049
Phone (813) 924-8911

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180511000891 FL Part B Supplier - Clinic/Group Practice 0840554234 Receives reassigned benefits from 1 practitioner
Practice locations: Dade City, FL

National Provider Directory

National Provider Directory

Locations

15000 Citrus Country Dr
#414
Dade City, FL 33523
Phone (813) 924-8911

5450 Bruce B Downs Blvd
Wesley Chapel, FL 33544
Phone (352) 232-3820

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": "1516752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617062400000",
    "number": "1235637398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15000 CITRUS COUNTRY DR # 414",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335236014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15000 CITRUS COUNTRY DR # 414",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335236014",
            "telephone_number": "813-924-8911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7715 Bulls Head Dr",
            "address_purpose": "LOCATION",
            "city": "Wesley Chapel",
            "state": "FL",
            "postal_code": "335457049",
            "country_code": "US",
            "telephone_number": "813-924-8911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BAY AREA MOBILE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-24",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A",
        "authorized_official_last_name": "BELIZAIRE",
        "authorized_official_first_name": "JUNISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-924-8911"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dade City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.