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Centerwell Senior Primary Care (NV) PC

Organization Active NPI Internal Medicine Physician · Las Vegas, NV

NPI 1770106155 · NPPES record last updated Feb 15, 2024

Key facts

NPI
1770106155
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE (NV) PC
Practice address
915 S Rainbow Blvd
Las Vegas, NV 89145-6230
Phone
(725) 220-8667
Fax
(833) 749-0353
NPI assigned
May 20, 2020
Organization subpart
Yes
Parent organization (as reported)
CENTERWELL SENIOR PRIMARY CARE (NV) PC

Authorized official

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

Other NPIs on the same Medicare enrollment 23

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

Corporate family (same tax ID) 16

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

Practitioners 10

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2197186Centerwell Senior Primary Care - South Rainbow
915 S Rainbow Blvd, Las Vegas, NV 89145		Certificate of waiverOct 21, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NV

Medicare enrollment records

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

National Provider Directory

Tax ID family
Centerwell Senior Primary Care NV P C (17 organizations share this tax ID)
Part of
Centerwell Senior Primary Care NV P C

Locations

3129 N Rainbow Blvd
Las Vegas, NV 89108
Phone (725) 220-8457

Specialties & licenses

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

Addresses

Primary practice location

915 S Rainbow Blvd
Las Vegas, NV 89145-6230

Mailing address

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

Other names

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

Other providers in Las Vegas, NV

All providers in Las Vegas, NV · Internal Medicine Physician in Nevada

Sources for this page

Verify at the official NPI Registry.