Centerwell Senior Primary Care (TX) PA
Organization Active NPI Internal Medicine Physician · Miami, FL
NPI 1912428533 · NPPES record last updated Jun 6, 2025
Key facts
- NPI
- 1912428533
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CENTERWELL SENIOR PRIMARY CARE (TX) PA
- Practice address
- 6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168 - Phone
- (407) 447-7120
- Fax
- (407) 770-0661
- NPI assigned
- Jul 5, 2017
- Organization subpart
- No
Authorized official
- Name
- Angie Martinez
- Title
- Senior Credentialing Professional
- Phone
- (407) 447-7120
Other NPIs on the same Medicare enrollment 35
Corporate family (same tax ID) 29
Practitioners 3
-
Renee Broussard, FNP
-
Andrew A Evans, MD
-
Mary Manis, M.S. M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190327001232 | TX | Part B Supplier - Clinic/Group Practice | 4789950247 |
Receives reassigned benefits from 132 practitioners 35 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Houston, TX; Humble, TX; McAllen, TX; Pantego, TX; Pasadena, TX; Port Arthur, TX; Richardson, TX; Richland Hills, TX… |
National Provider Directory
- Tax ID family
- Centerwell Senior Primary Care TX PA
Locations
6350 W Colonial Dr
Orlando, FL 32818
Phone (407) 281-1755
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| General Practice Physician |
208D00000X |
Addresses
Primary practice location
6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Mailing address
6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (407) 447-7120
Other names
- Partners In Primary Care TX, PA
- Partners in Primary Care KS, PA
Other providers in Miami, FL
- Centerwell Pharmacy, Inc.
- Centerwell Pharmacy, Inc.
- Centerwell Pharmacy, Inc.
- Centerwell Senior Primary Care (NC) PC
- Centerwell Senior Primary Care (NC) PC
- Centerwell Senior Primary Care Az CS PC
- Centerwell Senior Primary Care FL Inc
- Centerwell Senior Primary Care FL JV PLLC
- Centerwell Senior Primary Care Ga CS PC
- Centerwell Senior Primary Care Ga PC
All providers in Miami, FL · Internal Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.