CENTERWELL SENIOR PRIMARY CARE FL JV PLLC - NPI 1356178578

Q: 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.

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About Centerwell Senior Primary Care Fl Jv Pllc NPPES

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

CENTERWELL SENIOR PRIMARY CARE FL JV PLLC (NPI 1356178578), doing business as Conviva Hudson, is a healthcare organization registered as an internal medicine in Hudson, Florida and active in the NPI registry since September 2024. The organization holds a CLIA Waiver certificate valid through February 13, 2027 and lists Angie Martinez, Senior Credentialing Professional, as its authorized official.

NPPES Registry Identity

NPI1356178578

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameCENTERWELL SENIOR PRIMARY CARE FL JV PLLC

Location Address12582 US HIGHWAY 19Hudson, FL 34667-1952

Mailing Address6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168 · (407) 447-7120 · Fax (407) 770-0661

Phone(407) 447-7120

Organization SubpartYes

Authorized OfficialAngie MartinezSenior Credentialing Professional · (407) 447-7120

Enumeration DateSeptember 19, 2024

NPPES CertifiedSeptember 19, 2024

✔ NPI 1356178578 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

12582 US HIGHWAY 19, Hudson, FL 34667

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Other Names 1

Doing Business AsConviva Hudson

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 10D2318674

Centerwell Senior Primary Care Fl Jv PLLC Dba Conviva Senior Primary Care · Hudson, FL

Active · expires Feb 13, 2027

CLIA Number10D2318674

Laboratory TypePhysician Office

Certificate Effective DateFebruary 14, 2025

Certificate Expiration DateFebruary 13, 2027

Laboratory DirectorDr. Santhini Namagiri

Laboratory Phone(727) 516-8806

Laboratory LocationCenterwell Senior Primary Care Fl Jv PLLC Dba Conviva Senior Primary Care12582 Us Highway 19, Hudson, FL 34667

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 5

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

YANIN OTANO RAMON

Nurse Practitioner (Family)