Myrtle Ridge Primary Care, P.a

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

MYRTLE RIDGE PRIMARY CARE, P.A

Practice address

1539 Dale Mabry Hwy Ste 102
Lutz, FL 33548-3008

Phone

(813) 909-7102

Fax

(813) 909-0199

NPI assigned

Aug 27, 2021

Last updated

May 6, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Yudaisy Mogena

Title

Office Manager

Phone

(813) 909-7102

Specialties & licenses 2

Addresses

Other identifiers 1

Tax ID family

Myrtle Ridge Primary Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Myrtle Ridge Primary Care, P.a

  • General Practice Physician
  • Lutz, FL
  • NPI 1619504354
  NPD tax ID

Practitioners 1

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.

• Yudaisy Mogena Padron, PA

  • Physician Assistant
  • Lutz, FL
  • NPI 1831800218
  NPD

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1700553633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 DALE MABRY HWY STE 102",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335483008",
            "telephone_number": "813-909-7102",
            "fax_number": "813-909-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 DALE MABRY HWY STE 102",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335483008",
            "telephone_number": "813-909-7102",
            "fax_number": "813-909-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRTLE RIDGE PRIMARY CARE, P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-27",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "MOGENA",
        "authorized_official_first_name": "YUDAISY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "813-909-7102"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111603900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Myofascial Release and Women's Health LLC (Holistic Health Practitioners)
• Callie Myrick
• Myrtle Ridge Family Medicine, PA
• Myrtle Ridge Healthcare Center, LLC
• Myrtle Ridge Primary Care, P.a
• N Shape & Health Medicine LLC
• Marie Louise Nace
• Jordan Michael Nagle
• Sara Kietzman Nagy, M.S., CCC-SLP
• Jennifer Amy Nahon, L.AC.

• Case Management Agency in Lutz, FL
• Providers in Lutz, FL by specialty
• Case Management Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.