1. Home
  2. Directory
  3. Nevada
  4. Las Vegas
  5. General Practice
  6. NPI Profile
Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

1ST CLARK COUNTY MEDICAL CLINIC LLC
NPI 1154022523
General Practice in Las Vegas, NV

Active since March 13, 2023
4570 S EASTERN AVE STE 26, LAS VEGAS, NV 89119(702) 476-3345(702) 920-8596 Get Directions Write a Review

NPPES record last updated: September 30, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 30, 2026, Mar 4, 2026, Mar 13, 2023 (3 updates tracked since 2023).

About 1st Clark County Medical Clinic Llc NPPES

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

1ST CLARK COUNTY MEDICAL CLINIC LLC (NPI 1154022523) is a healthcare organization registered as a general practice in Las Vegas, Nevada and active in the NPI registry since March 2023. The organization lists Grezilda Mae Cabo, Ceo, as its authorized official.

NPPES Registry Identity

NPI1154022523
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business Name1ST CLARK COUNTY MEDICAL CLINIC LLC
Location Address4570 S EASTERN AVE STE 26Las Vegas, NV 89119-6183
Mailing Address4570 S Eastern Ave Ste 26Las Vegas, NV 89119-6183 · (702) 445-1196 · Fax (702) 920-8596
Phone(702) 476-3345
Fax(702) 920-8596
Organization SubpartNo
Authorized OfficialGrezilda Mae CaboCeo · (702) 445-1196
Enumeration DateMarch 13, 2023
Last NPPES UpdateSeptember 30, 20263 updates tracked since enumeration
NPPES CertifiedSeptember 30, 2026
✔ NPI 1154022523 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedPsychiatry & Neurology · Behavioral Neurology & NeuropsychiatryTaxonomy 2084B0040X
4570 S EASTERN AVE STE 26, Las Vegas, NV 89119
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

1st Clark County Medical Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to 1st Clark County Medical Clinic LLC, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Annette Kee, APRN PMHNP-BC
Nurse Practitioner
NPI 1710248505
1505 S EASTERN AVE
Las Vegas, NV 89104
(702) 885-0881
✔ PECOS✔ Accepts Medicare3.2 mi
Stephen Tam, MD
Internal Medicine
NPI 1689738478
5380 S RAINBOW #110
Las Vegas, NV 89118
(702) 838-3889
✔ PECOS✔ Accepts Medicare6.9 mi
Ellaine Manabat, MSN, APRN, PMHNP-BC
Nurse Practitioner
NPI 1689484412
8945 W RUSSELL RD STE 110
Las Vegas, NV 89148
(702) 476-9294
✔ PECOS9.5 mi
Linda Sims, MSW LCSW LADC
Clinical Social Worker
NPI 1427141738
912 W OWENS VA OF SOUTHERN NEVADA
North Las Vegas, NV 89036
(702) 395-1447
✔ PECOS15 mi
Daniel Sussman, M.D.
Psychiatry
NPI 1275575870
1530 LONE OAK RD
Paducah, KY 42003
(270) 444-2481
✔ PECOS✔ Accepts Medicare1,469 mi
Jeremy Creekmore, DNP, APRN, PMHNP-BC
Nurse Practitioner
NPI 1194164293
98-1247 KAAHUMANU ST STE 106
Aiea, HI 96701
(808) 675-8888
✔ PECOS✔ Accepts Medicare2,764 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 1st Clark County Medical Clinic LLC's NPI number?

The NPI number for 1st Clark County Medical Clinic LLC is 1154022523. It was assigned to this organization in the NPPES registry on March 13, 2023.

Where is 1st Clark County Medical Clinic LLC located?

1st Clark County Medical Clinic LLC is located at 4570 S Eastern Ave Ste 26, Las Vegas, NV 89119. The listed phone number is (702) 476-3345.

What is 1st Clark County Medical Clinic LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is 1st Clark County Medical Clinic LLC enrolled in Medicare?

Yes. 1st Clark County Medical Clinic LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through 1st Clark County Medical Clinic LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 4 Medicare specialties reassign their Medicare billing to 1st Clark County Medical Clinic LLC. 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 (3), Clinical Social Worker (1) and Internal Medicine (1). Of these, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for 1st Clark County Medical Clinic LLC was last updated on September 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 35 days 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.