NPIMap

Organization Active NPI

Your Family Walk-in Clinic LLC

  • Health Service Clinic/Center
  • Lutz, FL
National Provider Identifier
1609297928
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
2776972 Issued in FL
Legal business name
YOUR FAMILY WALK-IN CLINIC LLC
Practice address
17929 Hunting Bow Cir
Lutz, FL 33558-5378
Phone
(813) 792-8555
NPI assigned
Jan 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Authorized official

Name
Dr. Lisa Brunton, APRN
Title
Owner
Phone
(813) 792-8555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 2776972 FL Primary

Addresses

Primary practice location

17929 Hunting Bow Cir
Lutz, FL 33558-5378

Mailing address

17929 Hunting Bow Cir
Lutz, FL 33558-5378
Phone (727) 580-9131

Other identifiers 2

IdentifierTypeStateIssuer
302641800MedicaidFL
1154368883OtherFLMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140823000258 FL Part B Supplier - Clinic/Group Practice 6406074038 Receives reassigned benefits from 19 practitioners
Practice locations: Lutz, FL

National Provider Directory

National Provider Directory

Locations

17929 Hunting Bow Cir
Lutz, FL 33558
Phone (813) 792-8555

Practitioners & affiliated clinicians

Practitioners 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1388880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1609297928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17929 HUNTING BOW CIR",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335585378",
            "telephone_number": "727-580-9131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17929 HUNTING BOW CIR",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335585378",
            "telephone_number": "813-792-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR FAMILY WALK-IN CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-05",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "BRUNTON",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-792-8555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "FL",
            "license": "2776972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302641800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "1154368883",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutz, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; 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.