Bay Area Direct Client Care LLC

Primary specialty

Clinical & Laboratory Immunology (Internal Medicine) PhysicianTaxonomy code 207RI0001X

Legal business name

BAY AREA DIRECT CLIENT CARE LLC

Practice address

110 Lithia Pinecrest Rd Ste B
Brandon, FL 33511-5300

Phone

(813) 679-5122

NPI assigned

Jun 18, 2018

Organization subpart

No

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

Authorized official

Name

Deshae Martin, NURSE PRACTITIONERNPI 1861945719

Title

Administrative Director

Phone

(813) 585-7708

Specialties & licenses 7

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Home health agency certification: CCN 687243

Legal name

BAY AREA DIRECT CLIENT CARE LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jan 9, 2023

Last certification

Dec 21, 2022

Organization structure

LLCProprietary

Incorporated

Sep 26, 2007 in FL

Enrollment address

110 Lithia Pinecrest Rd
Ste B
Brandon, FL 33511-5300
HHA Branch

Other NPIs on the same Medicare enrollment 1

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

• Bay Area Direct Client Care LLC

  • In Home Supportive Care Agency
  • Brandon, FL
  • NPI 1003584301

  O20210225003406

  Same enrollment

Listed as

Bay Area Direct Client Care LLCCCN 687243

Ownership

-

Certified

Jan 9, 2023

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Bay Area Direct Client Care LLC

  • In Home Supportive Care Agency
  • Brandon, FL
  • NPI 1003584301

  Member Of

  NPD member

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Bay Area Direct Client Care LLC

  • In Home Supportive Care Agency
  • Brandon, FL
  • NPI 1003584301

  Operational/Managerial Control

  CMS ownership
• Deshae Martin, NURSE PRACTITIONER

  • Community Health Nurse Practitioner
  • Brandon, FL
  • NPI 1861945719

  5% Or Greater Direct Ownership Interest, Corporate Director, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deshae Martin, NURSE PRACTITIONER

  • Community Health Nurse Practitioner
  • Brandon, FL
  • NPI 1861945719

  Multi-Specialty

  NPD Authorized official

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623369600000",
    "number": "1356835862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 ROANOKE SPRINGS DR",
            "city": "RUSKIN",
            "state": "FL",
            "postal_code": "335706312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LITHIA PINECREST RD STE B",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115300",
            "telephone_number": "813-679-5122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2105 Roanoke Springs Dr",
            "address_purpose": "LOCATION",
            "city": "Ruskin",
            "state": "FL",
            "postal_code": "33570",
            "country_code": "US",
            "telephone_number": "813-679-5122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BAY AREA DIRECT CLIENT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-18",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "DESHAE",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "813-585-7708",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "207RI0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical & Laboratory Immunology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Day Training/Habilitation Specialist",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE ASSOCIATED",
            "identifier": "NONE",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025147900",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.practicefusion.com/",
            "affiliation": "N",
            "endpointDescription": "EMAR",
            "address_1": "110 Lithia Pinecrest Rd Ste B",
            "city": "Brandon",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335115300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Internal Medicine Physician in Brandon, FL
• Providers in Brandon, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.