Carrollwood Medical Group, LLC.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

CARROLLWOOD MEDICAL GROUP, LLC.

Doing business as

Revello Medical Center

Practice address

10213 Lake Carroll Way Ste B
Tampa, FL 33618-4402

Phone

(813) 888-8215

Fax

(813) 885-5398

NPI assigned

Aug 26, 2016

Organization subpart

No

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

Authorized official

Name

Antonio Calvo

Title

Coo

Phone

(813) 888-8215

Specialties & licenses 1

Addresses

Other names 1

• Revello Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

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

• Lazaro Perez, FNP

  • Family Nurse Practitioner
  • Tampa, FL
  • NPI 1841022050
  Medicare reassignment NPD
• Jorge Alejandro Aleman Cardenas, APRN

  • Adult Health Nurse Practitioner
  • Tampa, FL
  • NPI 1467152678
  NPD (past)
• Jose M Garcia, M.D.

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1023010832
  NPD (past)

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

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1982150348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 WEBB RD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336153219",
            "telephone_number": "813-888-8215",
            "fax_number": "813-885-5398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10213 LAKE CARROLL WAY STE B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336184402",
            "telephone_number": "813-888-8215",
            "fax_number": "813-885-5398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARROLLWOOD MEDICAL GROUP, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-26",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "CALVO",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "813-888-8215"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revello Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carrollwood Diagnostic Imaging
• Carrollwood Emergency Physicians PA
• Carrollwood Family Chiropractic LLC
• Carrollwood Family Medical and Rehabilitation Center, Inc.
• Carrollwood Massage Therapy
• Carrollwood Operations, LLC
• Carrollwood Rehabilitation Center LLC
• Carrollwood Speech and Swallowing Therapy, PLLC
• Carrollwood Surgical Associates
• Carrollwood Village Counseling Associates

• Clinic/Center in Tampa, FL
• Providers in Tampa, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; 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.