East Lake Medical Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

ME114777 Issued in FL

Legal business name

EAST LAKE MEDICAL CLINIC

Practice address

4737 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400

Phone

(407) 705-3222

NPI assigned

Jun 21, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Dustin Ly, MDNPI 1710195268

Title

President

Phone

(407) 705-3222

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/7278/brand/1/csg/1/fhir/r4

Practitioners 9

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

• Dustin N Ly, MD

  • Internal Medicine Physician
  • Saint Cloud, FL
  • NPI 1710195268
  Medicare reassignment Care Compare group NPD Authorized official
• Robert Benjamin Powers, D.O.

  • Hospitalist Physician
  • Orlando, FL
  • NPI 1578637112
  Medicare reassignment Care Compare group NPD
• Alisa K Romero, PA-C

  • Surgical Physician Assistant
  • Fort Myers, FL
  • NPI 1902102445
  Medicare reassignment NPD
• Arleen Velez

  • Family Nurse Practitioner
  • Orlando, FL
  • NPI 1598502288

  Multi-Specialty

  Medicare reassignment NPD
• Bianca F Peck, APRN

  • Family Nurse Practitioner
  • Tallahassee, FL
  • NPI 1013696160
  Medicare reassignment
• Krista Punto, APRN

  • Family Nurse Practitioner
  • Clermont, FL
  • NPI 1093417719
  NPD
• Adriana Mayret Velasquez Garcia

  • Family Nurse Practitioner
  • Altamonte Springs, FL
  • NPI 1083424246
  NPD
• Tochukwu Mayreen Okemezie

  • Physician Assistant
  • Union, NJ
  • NPI 1174321301
  NPD
• Minh-Chau Thi Tran

  • Family Nurse Practitioner
  • Kissimmee, FL
  • NPI 1902362122
  NPD (past)

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371772800000",
    "number": "1790124741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4737 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347691400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4737 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347691400",
            "telephone_number": "407-705-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST LAKE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "last_updated": "2013-06-21",
        "status": "A",
        "authorized_official_last_name": "LY",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-705-3222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME114777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eagle Eye Home Health Agency LLC
• Easewell LLC
• East Lake Chiropractic & Medical Center, Inc.
• East Lake Chiropractic and Injury Center Inc
• East Lake Dental PLLC
• Ebenezer Clinical Pharmacy LLC
• Edgemon & Associates, Inc
• Robert Joseph Edwards, MS
• Elba E. Masid, MD, LLC
• Charley Ann Elder

• Primary Care Clinic/Center in Saint Cloud, FL
• Providers in Saint Cloud, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; 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.