La Vida Medical Group , Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LA VIDA MEDICAL GROUP , INC

Practice address

120 State St E Ste 101
Oldsmar, FL 34677-3647

Phone

(813) 296-6266

NPI assigned

Jul 26, 2021

Organization subpart

No

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

Authorized official

Name

Sanlly Perez Ceballos, MDNPI 1356728067

Title

President

Phone

(813) 296-6266

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• La Vida Medical Group , Inc

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1437960077

  O20211012003000

  Same enrollment

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

CLIA laboratory certificates

Tax ID family

La Vida Medical Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• La Vida Medical Group , Inc

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1437960077
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• La Vida Medical Group , Inc

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1437960077
  NPPES parent name

Practitioners 3

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

• Sanlly Perez Ceballos, M.D.

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1356728067
  Medicare reassignment Care Compare group NPD Authorized official
• Francisco Tomas Fernandez Rodriguez, M.D.

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1679985956
  Medicare reassignment Care Compare group NPD
• Mayelin Perez Reina, NP

  • Family Nurse Practitioner
  • Saint Petersburg, FL
  • NPI 1831909985
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678406400000",
    "number": "1982377065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 STATE ST E STE 101",
            "city": "OLDSMAR",
            "state": "FL",
            "postal_code": "346773647",
            "telephone_number": "813-296-6266",
            "fax_number": "813-522-8929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 STATE ST E STE 101",
            "city": "OLDSMAR",
            "state": "FL",
            "postal_code": "346773647",
            "telephone_number": "813-296-6266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA VIDA MEDICAL GROUP , INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-26",
        "last_updated": "2023-03-10",
        "certification_date": "2021-09-08",
        "status": "A",
        "authorized_official_last_name": "PEREZ CEBALLOS",
        "authorized_official_first_name": "SANLLY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-296-6266",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Koutras, LMHC
• Priscilla Kuazko, DC
• Kurt Theodore OD PA
• Kathryn Emily Kutchins, LMHC
• La Mano Amiga Corp.
• Arlene A. Laing, ARNP
• Jake Lampe
• Deana M Lantz, ARNP-C
• Larry E. Stevens, M.D.
• Laser Spine International

• Internal Medicine Physician in Oldsmar, FL
• Providers in Oldsmar, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; 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.