NPIMap

Organization Active NPI

Primecare at Twin Lakes LLC

  • Urgent Care Clinic/Center
  • Daytona Beach, FL
National Provider Identifier
1902809122
Registry record updated Mar 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
ME47294 Issued in FL
Legal business name
PRIMECARE AT TWIN LAKES LLC
Practice address
1890 Lpga Blvd
Ste 130
Daytona Beach, FL 32117-7130
Phone
(386) 274-2212
Fax
(386) 274-1508
NPI assigned
May 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2022

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

Authorized official

Name
Charles Duva, M.D.
Title
President
Phone
(386) 274-7800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X ME47294 FL Primary

Addresses

Primary practice location

1890 Lpga Blvd
Ste 130
Daytona Beach, FL 32117-7130

Mailing address

1890 Lpga Blvd
Suite 130
Daytona Beach, FL 32117-7130
Phone (386) 274-2212

Other identifiers 3

IdentifierTypeStateIssuer
B90F7OtherFLFLORIDA BLUE
77984OtherFLBC/BS OF FL PA GROUP
DC0901OtherFLRAILROAD MEDICARE GROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040708000867 FL Part B Supplier - Clinic/Group Practice 3072591924 Receives reassigned benefits from 36 practitioners
Practice locations: New Smyrna Beach, FL; Daytona Beach, FL

National Provider Directory

National Provider Directory

Locations

1327 Saxon Dr
New Smyrna Beach, FL 32169
Phone (386) 767-2402

740 Dunlawton Ave
Ste 100
Port Orange, FL 32127
Phone (386) 767-2402

Practitioners & affiliated clinicians

Practitioners 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647820800000",
    "number": "1902809122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD",
            "address_2": "SUITE 130",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177130",
            "telephone_number": "386-274-2212",
            "fax_number": "386-274-1508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD",
            "address_2": "STE 130",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177130",
            "telephone_number": "386-274-2212",
            "fax_number": "386-274-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE AT TWIN LAKES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A",
        "authorized_official_last_name": "DUVA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-274-7800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "FL",
            "license": "ME47294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "B90F7",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF FL PA GROUP",
            "identifier": "77984",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "DC0901",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2022; 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.