1. Home
  2. Directory
  3. Florida
  4. Cape Coral
  5. General Practice
  6. NPI Profile

BLUESHINE MEDICAL CENTER LLC
NPI 1053138099
General Practice in Cape Coral, FL

Active since September 23, 2024CLIA 10D2325883 · Waiver
140 SANTA BARBARA BLVD STE 121, CAPE CORAL, FL 33991(305) 790-6544 Get Directions Write a Review

NPPES record last updated: September 23, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Blueshine Medical Center Llc NPPES

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

BLUESHINE MEDICAL CENTER LLC (NPI 1053138099) is a healthcare organization registered as a general practice in Cape Coral, Florida and active in the NPI registry since September 2024. The organization holds a CLIA Waiver certificate valid through June 22, 2027 and lists Jose Gustavo Cevallos, Provider, as its authorized official.

NPPES Registry Identity

NPI1053138099
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameBLUESHINE MEDICAL CENTER LLC
Location Address140 SANTA BARBARA BLVD STE 121Cape Coral, FL 33991-2160
Mailing Address205 Nw 15th PlCape Coral, FL 33993-7747 · (561) 762-1660
Phone(305) 790-6544
Organization SubpartNo
Authorized OfficialJose Gustavo CevallosProvider · (305) 790-6544
Enumeration DateSeptember 23, 2024
NPPES CertifiedSeptember 22, 2024
✔ NPI 1053138099 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
140 SANTA BARBARA BLVD STE 121, Cape Coral, FL 33991
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Blueshine Medical Center Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Blueshine Medical Center LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jose Cevallos Yepez, M.D.
Internal Medicine
NPI 1922236736
5353 N FEDERAL HWY STE 400
Cape Coral, FL 33904
(239) 460-4494
✔ PECOS✔ Accepts Medicare11 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 10D2325883

Blueshine Medical Center LLC · Cape Coral, FL
Active · expires Jun 22, 2027
CLIA Number10D2325883
Laboratory TypePhysician Office
Certificate Effective DateJune 23, 2025
Certificate Expiration DateJune 22, 2027
Laboratory DirectorJose G. Cevallos
Laboratory Phone(239) 212-1919
Laboratory LocationBlueshine Medical Center LLC140 Santa Barbara Blvd Suite 122, Cape Coral, FL 33991
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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 Blueshine Medical Center LLC's NPI number?

The NPI number for Blueshine Medical Center LLC is 1053138099. It was assigned to this organization in the NPPES registry on September 23, 2024.

Where is Blueshine Medical Center LLC located?

Blueshine Medical Center LLC is located at 140 Santa Barbara Blvd Ste 121, Cape Coral, FL 33991. The listed phone number is (305) 790-6544.

What is Blueshine Medical Center LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Blueshine Medical Center LLC enrolled in Medicare?

Yes. Blueshine Medical Center LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Blueshine Medical Center LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Blueshine Medical Center LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Blueshine Medical Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2325883) is associated with this NPI, valid through June 22, 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 Blueshine Medical Center LLC was last updated on September 23, 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.