CONVIVA SAN JOSE
NPI 1104653310
Internal Medicine in Jacksonville, FL
About Conviva San Jose NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CONVIVA SAN JOSE (NPI 1104653310) is a healthcare organization registered as an internal medicine in Jacksonville, Florida and active in the NPI registry since September 2024. The organization holds 2 active CLIA laboratory certificates and lists Angie Martinez, Senior Credentialing Professional, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Conviva San Jose is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
37Medicare enrollment records show 37 clinicians reassign Medicare billing to Conviva San Jose, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 5 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 4
Nearest to this location (20)
See all 37Winter Garden, FL 34787
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 2
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 10D2313754
Centerwell Senior Primary Care Fl Jv PLLC Dba Conviva Senior Primary Care · Jacksonville, FLCertificate of Waiver 10D2313691
Centerwell Senior Primary Care Fl Jv PLLC Dba Conviva Senior Primary Care · Jacksonville, 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 Centerwell Senior Primary Care Fl Jv PLLC's NPI number?
The NPI number for Centerwell Senior Primary Care Fl Jv PLLC is 1104653310. It was assigned to this organization in the NPPES registry on September 19, 2024. The provider is doing business as Conviva San Jose.
Where is Centerwell Senior Primary Care Fl Jv PLLC located?
Centerwell Senior Primary Care Fl Jv PLLC is located at 10991 San Jose Blvd # 100, Jacksonville, FL 32223. The listed phone number is (904) 839-1037.
What is Centerwell Senior Primary Care Fl Jv PLLC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Centerwell Senior Primary Care Fl Jv PLLC enrolled in Medicare?
Yes. Centerwell Senior Primary Care Fl Jv PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Centerwell Senior Primary Care Fl Jv PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 37 clinicians in 4 Medicare specialties reassign their Medicare billing to Centerwell Senior Primary Care Fl Jv PLLC. 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. The largest specialties are Nurse Practitioner (18), Family Practice (10) and General Practice (5). Of these, 1 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Centerwell Senior Primary Care Fl Jv PLLC hold CLIA laboratory certificates?
Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.
When was this NPI record last updated?
The NPPES record for Centerwell Senior Primary Care Fl Jv PLLC was last updated on December 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months 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.
# Conviva San Jose · NPI 1104653310
Internal Medicine organization in Jacksonville, Florida. Organization record, active in the CMS NPPES registry since September 19, 2024.
## Identity
- **NPI:** 1104653310 (Entity type: Organization)
- **Enumerated:** September 19, 2024
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Legal business name:** Centerwell Senior Primary Care Fl Jv Pllc
- **Organization subpart:** Yes (part of Centerwell Senior Primary Care Fl Jv Pllc)
- **Authorized official:** Angie Martinez, SENIOR CREDENTIALING PROFESSIONAL
## Practice location
- **Address:** 10991 SAN JOSE BLVD # 100, Jacksonville, FL 32223-6675
- **Phone:** (904) 839-1037
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 37 clinicians in 4 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (18), Family Practice (10), General Practice (5); 1 practice at this address and 5 within 10 miles; [full list](https://npiprofile.com/npi/1104653310/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 10, 2024
- **CLIA laboratory certificates:** 2 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1104653310) · Data from the CMS NPPES public registry.