CENTERWELL SENIOR PRIMARY CARE-W. CHARLESTON
NPI 1306625835
Internal Medicine in Las Vegas, NV

Active since September 25, 2023CLIA 29D2236632 · Waiver
4469 W CHARLESTON BLVD, LAS VEGAS, NV 89102(702) 832-4561(210) 761-3397 Get Directions Write a Review

NPPES record last updated: February 15, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Centerwell Senior Primary Care-w. Charleston NPPES

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

CENTERWELL SENIOR PRIMARY CARE-W. CHARLESTON (NPI 1306625835) is a healthcare organization registered as an internal medicine in Las Vegas, Nevada and active in the NPI registry since September 2023. The organization holds a CLIA Waiver certificate valid through September 16, 2027 and lists Angie Martinez, Senior Credentialing Professional, as its authorized official.

NPPES Registry Identity

NPI1306625835
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCENTERWELL SENIOR PRIMARY CARE (NV) PC
Location Address4469 W CHARLESTON BLVDLas Vegas, NV 89102-1605
Mailing Address4700 Millenia Blvd Ste 650Orlando, FL 32839-6013 · (407) 447-7120
Fax(210) 761-3397
Organization SubpartYes
Authorized OfficialAngie MartinezSenior Credentialing Professional · (407) 447-7120
Enumeration DateSeptember 25, 2023
Last NPPES UpdateFebruary 15, 2024
NPPES CertifiedFebruary 15, 2024
NPI 1306625835 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 ListedGeneral PracticeTaxonomy 208D00000X
4469 W CHARLESTON BLVD, Las Vegas, NV 89102

Other Names 1

Doing Business AsCenterwell Senior Primary Care-w. Charleston

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 29D2236632

Centerwell Senior Primary Care- W Charleston · Las Vegas, NV
Active · expires Sep 16, 2027
CLIA Number29D2236632
Laboratory TypePhysician Office
Certificate Effective DateSeptember 17, 2025
Certificate Expiration DateSeptember 16, 2027
Laboratory DirectorTracy J MD Wakefield
Laboratory Phone(702) 577-1910
Laboratory LocationCenterwell Senior Primary Care- W Charleston4469 West Charleston Blvd, Las Vegas, NV 89102
CLIA data matches this NPI record on: Address Name
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.

Nurse Practitioner (Family)
4469 W CHARLESTON BLVD
LAS VEGAS, NV 89102
Physician Assistant
4469 W CHARLESTON BLVD
LAS VEGAS, NV 89102
Family Medicine
4469 W CHARLESTON BLVD
LAS VEGAS, NV 89102

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 1306625835. It was assigned to this organization in the NPPES registry on September 25, 2023. The provider is doing business as Centerwell Senior Primary Care-W. Charleston.

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

Centerwell Senior Primary Care (nv) PC is located at 4469 W Charleston Blvd, Las Vegas, NV 89102. The listed phone number is (702) 832-4561.

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 29D2236632) is associated with this NPI, valid through September 16, 2027. 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 February 15, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.