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MEDICAL PAVILION CLINIC
NPI 1093901282
Specialist in Port Charlotte, FL

Active since September 20, 2007
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: October 25, 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 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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Medical Pavilion Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Medical Pavilion Clinic, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

David Ballestas, MD
Internal Medicine
NPI 1609969419
2525 HARBOR BLVD SUITE 102
Port Charlotte, FL 33952
(941) 629-7593
✔ PECOS✔ Accepts MedicareSame address
Michael Lawson, ARNP
Nurse Practitioner
NPI 1043449960
2525 HARBOR BLVD SUITE 102
Port Charlotte, FL 33952
(941) 629-9190
✔ PECOSSame address
Ricardo Guzman Matos, APRN
Nurse Practitioner
NPI 1205570975
1632 NW 2ND ST
Cape Coral, FL 33993
(305) 846-2348
✔ PECOS✔ Accepts Medicare24 mi

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

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.

Is David S Ballestas MD PA enrolled in Medicare?

Yes. David S Ballestas MD PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through David S Ballestas MD PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to David S Ballestas MD PA, in Internal Medicine and Nurse Practitioner. 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. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.