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CENTERWELL SENIOR PRIMARY CARE-BLUE DIAMOND
NPI 1043926777
Internal Medicine in Las Vegas, NV

Active since January 26, 2023CLIA 29D2285208 · Waiver
4517 BLUE DIAMOND RD, LAS VEGAS, NV 89139(725) 258-2982(877) 709-4341 Get Directions Write a Review

NPPES record last updated: July 3, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 3, 2024, Jan 26, 2023 (2 updates tracked since 2023).

About Centerwell Senior Primary Care-blue Diamond NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CENTERWELL SENIOR PRIMARY CARE-BLUE DIAMOND (NPI 1043926777) is a healthcare organization registered as an internal medicine in Las Vegas, Nevada and active in the NPI registry since January 2023. The organization holds a CLIA Waiver certificate valid through July 6, 2027 and lists Angie Martinez, Senior Credentialing Professional, as its authorized official.

NPPES Registry Identity

NPI1043926777
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCENTERWELL SENIOR PRIMARY CARE (NV) PC
Location Address4517 BLUE DIAMOND RDLas Vegas, NV 89139-7620
Mailing Address6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168 · (305) 500-2000
Phone(725) 258-2982
Fax(877) 709-4341
Organization SubpartYes
Authorized OfficialAngie MartinezSenior Credentialing Professional · (407) 447-7120
Enumeration DateJanuary 26, 2023
Last NPPES UpdateJuly 3, 20242 updates tracked since enumeration
NPPES CertifiedJuly 3, 2024
✔ NPI 1043926777 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedInternal Medicine · Interventional CardiologyTaxonomy 207RI0011X
Also ListedGeneral PracticeTaxonomy 208D00000X
4517 BLUE DIAMOND RD, Las Vegas, NV 89139
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Other Names 1

Doing Business AsCenterwell Senior Primary Care-blue Diamond

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 29D2285208

Centerwell Senior Primary Care- Blue Diamond · Las Vegas, NV
Active · expires Jul 6, 2027
CLIA Number29D2285208
Laboratory TypePhysician Office
Certificate Effective DateJuly 7, 2025
Certificate Expiration DateJuly 6, 2027
Laboratory DirectorTracy J Wakefield
Laboratory Phone(725) 258-2982
Laboratory LocationCenterwell Senior Primary Care- Blue Diamond4517 Blue Diamond Road, Las Vegas, NV 89139
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NANCY TE LAO MD
Family Medicine
4517 BLUE DIAMOND RD
LAS VEGAS, NV 89139
Clark County (725) 258-2982
SONIA GARCIA-JAYNE D.O.
Family Medicine
4517 BLUE DIAMOND RD
LAS VEGAS, NV 89139
Clark County (725) 258-2982
CHESTER C. ROBERT WHITLEY IV P.A.-C
Physician Assistant
4517 BLUE DIAMOND RD
LAS VEGAS, NV 89139
Clark County (725) 258-2982

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Centerwell Senior Primary Care (nv) PC's NPI number?

The NPI number for Centerwell Senior Primary Care (nv) PC is 1043926777. It was assigned to this organization in the NPPES registry on January 26, 2023. The provider is doing business as Centerwell Senior Primary Care-Blue Diamond.

Where is Centerwell Senior Primary Care (nv) PC located?

Centerwell Senior Primary Care (nv) PC is located at 4517 Blue Diamond Rd, Las Vegas, NV 89139. The listed phone number is (725) 258-2982.

What is Centerwell Senior Primary Care (nv) PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Centerwell Senior Primary Care (nv) PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 29D2285208) is associated with this NPI, valid through July 6, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Centerwell Senior Primary Care (nv) PC was last updated on July 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.