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CONVIVA SAN JOSE
NPI 1104653310
Internal Medicine in Jacksonville, FL

Active since September 19, 2024CLIA Certified · 2 labs
10991 SAN JOSE BLVD # 100, JACKSONVILLE, FL 32223(904) 839-1037 Get Directions Write a Review

NPPES record last updated: December 10, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 10, 2024, Sep 19, 2024 (2 updates tracked since 2024).

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

NPI1104653310
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCENTERWELL SENIOR PRIMARY CARE FL JV PLLC
Location Address10991 SAN JOSE BLVD # 100Jacksonville, FL 32223-6675
Mailing Address6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168 · (407) 447-7120 · Fax (407) 770-0661
Phone(904) 839-1037
Organization SubpartYes
Authorized OfficialAngie MartinezSenior Credentialing Professional · (407) 447-7120
Enumeration DateSeptember 19, 2024
Last NPPES UpdateDecember 10, 20242 updates tracked since enumeration
NPPES CertifiedDecember 10, 2024
✔ NPI 1104653310 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedGeneral PracticeTaxonomy 208D00000X
10991 SAN JOSE BLVD # 100, Jacksonville, FL 32223
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Other Names 1

Doing Business AsConviva San Jose

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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, FL
Active · expires Nov 5, 2026
CLIA Number10D2313754
Laboratory TypePhysician Office
Certificate Effective DateNovember 6, 2024
Certificate Expiration DateNovember 5, 2026
Laboratory DirectorSravan K. Thangeda
Laboratory Phone(904) 839-1263
Laboratory LocationCenterwell Senior Primary Care Fl Jv PLLC Dba Conviva Senior Primary Care10991 San Jose Blvd, Jacksonville, FL 32223
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2313691

Centerwell Senior Primary Care Fl Jv PLLC Dba Conviva Senior Primary Care · Jacksonville, FL
Active · expires Nov 4, 2026
CLIA Number10D2313691
Laboratory TypePhysician Office
Certificate Effective DateNovember 5, 2024
Certificate Expiration DateNovember 4, 2026
Laboratory DirectorNanako Broughton
Laboratory Phone(904) 839-1037
Laboratory LocationCenterwell Senior Primary Care Fl Jv PLLC Dba Conviva Senior Primary Care11900 Atlantic Blvd, Jacksonville, FL 32225
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

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

SRAVAN K THANGEDA MD
Internal Medicine
10991 SAN JOSE BLVD # 100
JACKSONVILLE, FL 32223
Duval County (904) 839-1263
RAQUEL PEREZ FNP
Nurse Practitioner (Family)
10991 SAN JOSE BLVD # 100
JACKSONVILLE, FL 32223
Duval County (904) 839-1263

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 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.

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 20 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.