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ELLENTON FAMILY PRACTICE DIRECT PLLC
NPI 1124471503
Family Medicine in Ellenton, FL

Active since July 20, 2016CLIA 10D2123741 · Waiver
907 25TH DR E, ELLENTON, FL 34222(941) 321-8299 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 7, 2023, Jan 12, 2018 (2 updates tracked since 2018).

About Ellenton Family Practice Direct Pllc NPPES

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

ELLENTON FAMILY PRACTICE DIRECT PLLC (NPI 1124471503) is a healthcare organization registered as a family medicine in Ellenton, Florida and active in the NPI registry since July 2016. The organization holds a CLIA Waiver certificate valid through December 29, 2026 and lists David Allan Hervig, Office Manage And Partner, as its authorized official.

NPPES Registry Identity

NPI1124471503
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameELLENTON FAMILY PRACTICE DIRECT PLLC
Location Address907 25TH DR EEllenton, FL 34222-2053
Mailing Address907 25th Dr EEllenton, FL 34222-2053 · (941) 417-7386
Phone(941) 321-8299
Organization SubpartNo
Authorized OfficialDavid Allan HervigOffice Manage And Partner · (941) 730-5326
Enumeration DateJuly 20, 2016
Last NPPES UpdateMarch 7, 20232 updates tracked since enumeration
✔ NPI 1124471503 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in FL · PA9102767
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
907 25TH DR E, Ellenton, FL 34222
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Other Identifiers 1

OtherOS12316FL · License

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 10D2123741

Ellenton Family Practice Direct · Ellenton, FL
Active · expires Dec 29, 2026
CLIA Number10D2123741
Laboratory TypePhysician Office
Certificate Effective DateDecember 30, 2024
Certificate Expiration DateDecember 29, 2026
Laboratory DirectorRaphael Kulawik
Laboratory Phone(941) 417-7386
Laboratory LocationEllenton Family Practice Direct907 25th Dr, E, Ellenton, FL 34222
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

DR ROMAIN ONTENIENTE LLC
Podiatrist (Foot & Ankle Surgery)
907 25TH DR E
ELLENTON, FL 34222
Manatee County (941) 417-7386
JULIE VERA RIVAS MSN, APRN, FNP-C
Nurse Practitioner (Family)
907 25TH DR E
ELLENTON, FL 34222
Manatee County (941) 417-7386
RENATA KULAWIK PHARMD
Pharmacist
907 25TH DR E
ELLENTON, FL 34222
Manatee County (941) 417-7386

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 Ellenton Family Practice Direct PLLC's NPI number?

The NPI number for Ellenton Family Practice Direct PLLC is 1124471503. It was assigned to this organization in the NPPES registry on July 20, 2016.

Where is Ellenton Family Practice Direct PLLC located?

Ellenton Family Practice Direct PLLC is located at 907 25th Dr E, Ellenton, FL 34222. The listed phone number is (941) 321-8299.

What is Ellenton Family Practice Direct PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Ellenton Family Practice Direct PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2123741) is associated with this NPI, valid through December 29, 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 Ellenton Family Practice Direct PLLC was last updated on March 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.