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MILLENNIUM PHYSICIAN GROUP LLC
NPI 1417610403
Family Medicine in Tampa, FL

Active since October 18, 2021CLIA Certified · 3 labs
15416 N FLORIDA AVE, TAMPA, FL 33613(813) 723-5450(813) 723-5451 Get Directions Write a Review

NPPES record last updated: January 18, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 18, 2023, Oct 18, 2021 (2 updates tracked since 2021).

About Millennium Physician Group Llc NPPES

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

MILLENNIUM PHYSICIAN GROUP LLC (NPI 1417610403) is a healthcare organization registered as a family medicine in Tampa, Florida and active in the NPI registry since October 2021. The organization holds 3 active CLIA laboratory certificates and lists Mary Haltigan, Director Of Revenue Cycle, as its authorized official.

NPPES Registry Identity

NPI1417610403
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMILLENNIUM PHYSICIAN GROUP LLC
Location Address15416 N FLORIDA AVETampa, FL 33613-1244
Mailing Address2675 Winkler Ave Fl 2Fort Myers, FL 33901-9342 · (877) 856-3774 · Fax (239) 599-2612
Phone(813) 723-5450
Fax(813) 723-5451
Organization SubpartNo
Authorized OfficialMary HaltiganDirector Of Revenue Cycle · (877) 856-3774
Enumeration DateOctober 18, 2021
Last NPPES UpdateJanuary 18, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 18, 2023
✔ NPI 1417610403 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
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.

15416 N FLORIDA AVE, Tampa, FL 33613
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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

CLIA Laboratory Certificates CMS CLIA 3

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 10D1073170

Millennium Physician Group, LLC · Tampa, FL
Active · expires Sep 3, 2027
CLIA Number10D1073170
Laboratory TypePhysician Office
Certificate Effective DateSeptember 4, 2025
Certificate Expiration DateSeptember 3, 2027
Laboratory DirectorSamuel Fuentes Flores
Laboratory Phone(813) 932-0996
Laboratory LocationMillennium Physician Group, LLC8521 N Armenia Ave, Tampa, FL 33604
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1097660

Millennium Physician Group, LLC · Tampa, FL
Active · expires Mar 31, 2027
CLIA Number10D1097660
Laboratory TypePhysician Office
Certificate Effective DateApril 1, 2025
Certificate Expiration DateMarch 31, 2027
Laboratory DirectorHarry Choi
Laboratory Phone(813) 972-5420
Laboratory LocationMillennium Physician Group, LLC3000 Medical Park Dr Ste 450, Tampa, FL 33613
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D0290316

Millennium Physician Group, LLC · Tampa, FL
Active · expires Aug 31, 2026
CLIA Number10D0290316
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorNadia Jivani
Laboratory Phone(813) 871-2959
Laboratory LocationMillennium Physician Group, LLC2919 Swann Ave Ste 400A, Tampa, FL 33609
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 9

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

MRS. CASEY LIN VIERA ARNP
Nurse Practitioner
15416 N FLORIDA AVE
TAMPA, FL 33613
Hillsborough County (813) 960-2400
DR. SARADA M REDDY MD
Radiology (Radiation Oncology)
15416 N FLORIDA AVE
TAMPA, FL 33613
Hillsborough County (813) 960-2400
DR. JENNIFER W GERSON MD
Radiology (Radiation Oncology)
15416 N FLORIDA AVE
TAMPA, FL 33613
Hillsborough County (813) 960-2400
BERNARD F GERMAIN, MD PA
Dermatology
15416 N FLORIDA AVE
TAMPA, FL 33613
Hillsborough County (813) 960-2400
MILLENNIUM PHYSICIAN GROUP LLC
Family Medicine
15416 N FLORIDA AVE
TAMPA, FL 33613
Hillsborough County (813) 723-5450
KASSANDRA PRICE PA
Physician Assistant
15416 N FLORIDA AVE
TAMPA, FL 33613
Hillsborough County (813) 960-2400
SET SOLUTION LLC
Radiology (Radiation Oncology)
15416 N FLORIDA AVE, RADIATION THERAPY SUITE
TAMPA, FL 33613
Hillsborough County (813) 497-7757
ANDJELA NEMCEVIC MD
Dermatology
15416 N FLORIDA AVE
TAMPA, FL 33613
Hillsborough County (813) 960-2400

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 Millennium Physician Group LLC's NPI number?

The NPI number for Millennium Physician Group LLC is 1417610403. It was assigned to this organization in the NPPES registry on October 18, 2021.

Where is Millennium Physician Group LLC located?

Millennium Physician Group LLC is located at 15416 N Florida Ave, Tampa, FL 33613. The listed phone number is (813) 723-5450.

What is Millennium Physician Group LLC's specialty?

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

Does Millennium Physician Group LLC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Millennium Physician Group LLC accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Millennium Physician Group LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Millennium Physician Group LLC was last updated on January 18, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.