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MEDICAL PAVILION CLINIC
NPI 1093901282
Specialist in Port Charlotte, FL

Active since September 20, 2007CLIA 10D0294616 · Waiver
2525 HARBOR BLVD, SUITE 102, PORT CHARLOTTE, FL 33952(941) 629-7593(941) 625-2751 Get Directions Write a Review

NPPES record last updated: May 9, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Medical Pavilion Clinic NPPES

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

MEDICAL PAVILION CLINIC (NPI 1093901282) is a healthcare organization registered as a specialist in Port Charlotte, Florida and active in the NPI registry since September 2007. The organization holds a CLIA Waiver certificate valid through August 25, 2026 and lists David S. Ballestas, Owner/president, as its authorized official.

NPPES Registry Identity

NPI1093901282
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameDAVID S BALLESTAS MD PA
Location Address2525 HARBOR BLVD, SUITE 102Port Charlotte, FL 33952-5317
Mailing Address2525 Harbor Blvd, Suite 102Port Charlotte, FL 33952-5317 · (941) 629-7593 · Fax (941) 625-2751
Phone(941) 629-7593
Fax(941) 625-2751
Organization SubpartNo
Authorized OfficialDavid S. BallestasOwner/president · (941) 629-7593
Enumeration DateSeptember 20, 2007
Last NPPES UpdateMay 9, 2008
✔ NPI 1093901282 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in FL · H87694
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
2525 HARBOR BLVD, Port Charlotte, FL 33952
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Other Names 1

Doing Business AsMedical Pavilion Clinic

Other Identifiers 2

Other40389FL · Medicare Group Number
Medicare NSC4617940001FL

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

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 10D0294616

David S Ballestas MD · Port Charlotte, FL
Active · expires Aug 25, 2026
CLIA Number10D0294616
Laboratory TypePhysician Office
Certificate Effective DateAugust 26, 2024
Certificate Expiration DateAugust 25, 2026
Laboratory DirectorDavid S. Ballestas MD
Laboratory Phone(941) 629-9190
Laboratory LocationDavid S Ballestas MD2525 Harbor Blvd # 102, Port Charlotte, FL 33952
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

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

SAMANTHA JEAN M.D.
Family Medicine
2525 HARBOR BLVD, SUITE 308
PORT CHARLOTTE, FL 33952
Charlotte County (419) 629-7777
MICHAEL JAMES LAWSON ARNP
Nurse Practitioner
2525 HARBOR BLVD, SUITE 102
PORT CHARLOTTE, FL 33952
Charlotte County (941) 629-9190
LUIS GERARDO MARMOL M.D.
Otolaryngology
2525 HARBOR BLVD, SUITE # 303
PORT CHARLOTTE, FL 33952
Charlotte County (941) 235-1901
MEDICAL PAVILION CLINC
Preferred Provider Organization
2525 HARBOR BLVD, SUITE 102
PORT CHARLOTTE, FL 33952
Charlotte County (941) 629-9190
STEPHEN PETROFSKY DPM PA
Durable Medical Equipment & Medical Supplies
2525 HARBOR BLVD, SUITE 206
PT CHARLOTTE, FL 33952
Charlotte County (941) 625-3330
DR. ANTONIO LABITAG GABARDA M.D.
Internal Medicine (Hematology & Oncology)
2525 HARBOR BLVD, SUITE 205
PORT CHARLOTTE, FL 33952
Charlotte County (941) 629-4660
DR. JEROME B COHEN MD
Internal Medicine
2525 HARBOR BLVD, 104
PORT CHARLOTTE, FL 33952
Charlotte County (941) 629-5757
JENS CHRISTIAN CARLSEN DO
Urology
2525 HARBOR BLVD, SUITE 201A
PORT CHARLOTTE, FL 33952
Charlotte County (941) 421-0756

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 David S Ballestas MD PA's NPI number?

The NPI number for David S Ballestas MD PA is 1093901282. It was assigned to this organization in the NPPES registry on September 20, 2007. The provider is doing business as Medical Pavilion Clinic.

Where is David S Ballestas MD PA located?

David S Ballestas MD PA is located at 2525 Harbor Blvd Suite 102, Port Charlotte, FL 33952. The listed phone number is (941) 629-7593.

What is David S Ballestas MD PA's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does David S Ballestas MD PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D0294616) is associated with this NPI, valid through August 25, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for David S Ballestas MD PA was last updated on May 9, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.