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CENTERWELL SENIOR PRIMARY CARE-SOUTH MLK
NPI 1215503065
Internal Medicine in Las Vegas, NV

Active since June 02, 2021CLIA 29D2247891 · Waiver
80 S MARTIN LUTHER KING BLVD STE 100, LAS VEGAS, NV 89106(725) 228-4500(877) 889-2823 Get Directions Write a Review

NPPES record last updated: July 3, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 3, 2024, Oct 20, 2022, Oct 4, 2021 and 1 more (4 updates tracked since 2021).

About Centerwell Senior Primary Care-south Mlk NPPES

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

CENTERWELL SENIOR PRIMARY CARE-SOUTH MLK (NPI 1215503065) is a healthcare organization registered as an internal medicine in Las Vegas, Nevada and active in the NPI registry since June 2021. The organization holds a CLIA Waiver certificate valid through January 9, 2028 and lists Angie Martinez, Senior Credentialing Professional, as its authorized official.

NPPES Registry Identity

NPI1215503065
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCENTERWELL SENIOR PRIMARY CARE (NV) PC
Location Address80 S MARTIN LUTHER KING BLVD STE 100Las Vegas, NV 89106-4325
Mailing Address6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168 · (305) 500-2000
Phone(725) 228-4500
Fax(877) 889-2823
Organization SubpartYes
Authorized OfficialAngie MartinezSenior Credentialing Professional · (407) 447-7120
Enumeration DateJune 2, 2021
Last NPPES UpdateJuly 3, 20244 updates tracked since enumeration
NPPES CertifiedJuly 3, 2024
✔ NPI 1215503065 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ 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 ListedInternal Medicine · Interventional CardiologyTaxonomy 207RI0011X
Also ListedGeneral PracticeTaxonomy 208D00000X
80 S MARTIN LUTHER KING BLVD STE 100, Las Vegas, NV 89106
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Other Names 1

Doing Business AsCenterwell Senior Primary Care-south Mlk

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

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 29D2247891

Centerwell Senior Primary Care-S Mlk · Las Vegas, NV
Active · expires Jan 9, 2028
CLIA Number29D2247891
Laboratory TypePhysician Office
Certificate Effective DateJanuary 10, 2026
Certificate Expiration DateJanuary 9, 2028
Laboratory DirectorTracy Wakefield
Laboratory Phone(725) 228-4500
Laboratory LocationCenterwell Senior Primary Care-S Mlk80 S Martin Luther King Blvd Ste 100, Las Vegas, NV 89106
CLIA data matches this NPI record on: Address 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.

WILLIAM DALRYMPLE IV D.O.
Family Medicine
80 S MARTIN LUTHER KING BLVD STE 100
LAS VEGAS, NV 89106
Clark County (725) 228-4500
MICHELLE PELAGIO FNP-C
Nurse Practitioner (Family)
80 S MARTIN LUTHER KING BLVD STE 100
LAS VEGAS, NV 89106
Clark County (725) 228-4500
DR. BINH N TRAN MD
Family Medicine
80 S MARTIN LUTHER KING BLVD STE 100
LAS VEGAS, NV 89106
Clark County (725) 228-4500

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 (nv) PC's NPI number?

The NPI number for Centerwell Senior Primary Care (nv) PC is 1215503065. It was assigned to this organization in the NPPES registry on June 2, 2021. The provider is doing business as Centerwell Senior Primary Care-South Mlk.

Where is Centerwell Senior Primary Care (nv) PC located?

Centerwell Senior Primary Care (nv) PC is located at 80 S Martin Luther King Blvd Ste 100, Las Vegas, NV 89106. The listed phone number is (725) 228-4500.

What is Centerwell Senior Primary Care (nv) PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Centerwell Senior Primary Care (nv) PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 29D2247891) is associated with this NPI, valid through January 9, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Centerwell Senior Primary Care (nv) PC was last updated on July 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.