SOUTH LAKE PRIMARY CARE P A
NPI 1053613232
Clinic/Center - Primary Care in Clermont, FL
About South Lake Primary Care P A NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTH LAKE PRIMARY CARE P A (NPI 1053613232) is a healthcare organization registered as a primary care in Clermont, Florida and active in the NPI registry since November 2010. The organization holds a CLIA Waiver certificate valid through October 5, 2027 and lists Ramon Sueiro, Md, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 3
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
South Lake Primary Care P A 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 South Lake Primary Care P A, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 10D0966029
South Lake Primary Care PA · Clermont, FLFrequently 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 South Lake Primary Care P A's NPI number?
The NPI number for South Lake Primary Care P A is 1053613232. It was assigned to this organization in the NPPES registry on November 22, 2010.
Where is South Lake Primary Care P A located?
South Lake Primary Care P A is located at 1503 Sunrise Plaza Dr, Clermont, FL 34714. The listed phone number is (352) 243-3800.
What is South Lake Primary Care P A's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is South Lake Primary Care P A enrolled in Medicare?
Yes. South Lake Primary Care P A is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through South Lake Primary Care P A?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to South Lake Primary Care P A. 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 South Lake Primary Care P A hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 10D0966029) is associated with this NPI, valid through October 5, 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 South Lake Primary Care P A was last updated on August 30, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.
# South Lake Primary Care P A · NPI 1053613232
Primary Care organization in Clermont, Florida. Organization record, active in the CMS NPPES registry since November 22, 2010.
## Identity
- **NPI:** 1053613232 (Entity type: Organization)
- **Enumerated:** November 22, 2010
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Ramon Sueiro, MD
## Practice location
- **Address:** 1503 SUNRISE PLAZA DR, Clermont, FL 34714-6200
- **Phone:** (352) 243-3800 · **Fax:** (352) 243-3804
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 30, 2013
- **Other identifiers:** Medicare UPIN G35745 (FL); Medicaid 250594100 (FL); Medicare PIN 31611A (FL)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1053613232) · Data from the CMS NPPES public registry.