NPIMap

Organization Active NPI

Centerwell Senior Primary Care (NV) PC

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1306469788
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE (NV) PC
Practice address
2875 S Nellis Blvd Ste 3
Las Vegas, NV 89121-2087
Phone
(702) 843-2420
Fax
(833) 749-0351
NPI assigned
May 20, 2020
Organization subpart
Yes
Parent organization
CENTERWELL SENIOR PRIMARY CARE (NV) PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

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

Authorized official

Name
Angie Martinez
Title
Senior Credentialing Professional
Phone
(407) 447-7120

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

2875 S Nellis Blvd Ste 3
Las Vegas, NV 89121-2087

Mailing address

4700 Millenia Blvd Ste 650
Orlando, FL 32839-6013
Phone (407) 447-7120

Other names 2

  • CenterWell Senior Primary Care-South Nellis Doing business as
  • Partners in Primary Care NV PC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200901001111 NV Part B Supplier - Clinic/Group Practice 5092132340 Receives reassigned benefits from 97 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV; North Las Vegas, NV; Henderson, NV

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

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
29D2197195Centerwell Senior Primary Care - South Nellis2875 S Nellis Blvd Ste 3, Las Vegas, NV 89121Certificate of waiverOct 21, 2026

National Provider Directory

National Provider Directory
Tax ID family
Centerwell Senior Primary Care NV P C17 organizations share this tax ID, including this one
Part of
Centerwell Senior Primary Care NV P C

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Locations

4001 S Decatur Blvd
Ste 25
Las Vegas, NV 89103
Phone (725) 224-6967

2875 S Nellis Blvd
Ste 3
Las Vegas, NV 89121
Phone (702) 843-2420

2875 S Nellis Blvd
Las Vegas, NV 89121
Phone (702) 905-1231

Practitioners & affiliated clinicians

Practitioners 7

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": "1589932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1306469788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 MILLENIA BLVD STE 650",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328396013",
            "telephone_number": "407-447-7120",
            "fax_number": "407-770-0661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 S NELLIS BLVD STE 3",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891212087",
            "telephone_number": "702-843-2420",
            "fax_number": "833-749-0351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE (NV) PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERWELL SENIOR PRIMARY CARE (NV) PC",
        "enumeration_date": "2020-05-20",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenterWell Senior Primary Care-South Nellis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care NV PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; 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.