Organization Active NPI

Primary Care of Nevada LLC

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1598459885
Registry record updated Jun 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRIMARY CARE OF NEVADA LLC
Practice address
601 S 10TH St # 101
Las Vegas, NV 89101-7027
Phone
(702) 823-5400
Fax
(702) 825-8584
NPI assigned
Jun 8, 2023
Last updated
Jun 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2025

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

Authorized official

Name
Phung JeffersonNPI 1598107591
Title
Coo
Phone
(702) 823-5400

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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

601 S 10TH St # 101
Las Vegas, NV 89101-7027

Mailing address

601 S 10TH St # 101
Las Vegas, NV 89101-7027
Phone (702) 823-5400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231025002072 NV Part B Supplier - Clinic/Group Practice 6709232861 Receives reassigned benefits from 3 practitioners
Practice locations: Las Vegas, NV

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
29D2294113Primary Care of Nevada601 S 10TH St Ste 101, Las Vegas, NV 89101Certificate of waiverNov 17, 2027

National Provider Directory

National Provider Directory

Locations

601 S 10th St
#101
Las Vegas, NV 89101
Phone (702) 823-5400

601 S 10th St
Ste 101
Las Vegas, NV 89101
Phone (702) 401-3632

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1686182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750291200000",
    "number": "1598459885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S 10TH ST # 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891017027",
            "telephone_number": "702-823-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S 10TH ST # 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891017027",
            "telephone_number": "702-823-5400",
            "fax_number": "702-825-8584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF NEVADA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-08",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-19",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "PHUNG",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "702-823-5400"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 19, 2025; 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.