MYRTLE RIDGE PRIMARY CARE, P.A
NPI 1619504354
General Practice in Lutz, FL
About Myrtle Ridge Primary Care, P.a NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MYRTLE RIDGE PRIMARY CARE, P.A (NPI 1619504354) is a healthcare organization registered as a general practice in Lutz, Florida and active in the NPI registry since March 2020. The organization holds a CLIA Waiver certificate valid through April 23, 2028 and lists Yudaisy Mogena Padron, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 4
Other Names 1
Other Identifiers 3
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Myrtle Ridge Primary Care, P.a is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Myrtle Ridge Primary Care, P.A, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (4)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 10D1050075
Myrtle Ridge Primary Care PA · Lutz, FLFrequently 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 Myrtle Ridge Primary Care, P.A's NPI number?
The NPI number for Myrtle Ridge Primary Care, P.A is 1619504354. It was assigned to this organization in the NPPES registry on March 24, 2020.
Where is Myrtle Ridge Primary Care, P.A located?
Myrtle Ridge Primary Care, P.A is located at 1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548. The listed phone number is (813) 909-7102.
What is Myrtle Ridge Primary Care, P.A's specialty?
The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.
Is Myrtle Ridge Primary Care, P.A enrolled in Medicare?
Yes. Myrtle Ridge Primary Care, P.A is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Myrtle Ridge Primary Care, P.A?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Myrtle Ridge Primary Care, P.A, in Certified Clinical Nurse Specialist (CNS), Clinical Psychologist, General Practice and Nurse Practitioner. 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. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Myrtle Ridge Primary Care, P.A hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 10D1050075) is associated with this NPI, valid through April 23, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Myrtle Ridge Primary Care, P.A accept?
Health plans from AmeriHealth Caritas Next, Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Myrtle Ridge Primary Care, P.A 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 Myrtle Ridge Primary Care, P.A was last updated on January 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months 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.
# Myrtle Ridge Primary Care, P.a · NPI 1619504354
General Practice organization in Lutz, Florida. Organization record, active in the CMS NPPES registry since March 24, 2020.
## Identity
- **NPI:** 1619504354 (Entity type: Organization)
- **Enumerated:** March 24, 2020
- **Primary specialty:** General Practice · taxonomy 208D00000X
- **Also known as:** Myrtle Ridge Primary Care, P.A (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Yudaisy Mogena Padron, OWNER
## Practice location
- **Address:** 1539 DALE MABRY HWY STE 102, Lutz, FL 33548-3008
- **Phone:** (813) 909-7102 · **Fax:** (813) 909-0199
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians in 4 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Certified Clinical Nurse Specialist (CNS) (1), Clinical Psychologist (1), General Practice (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 8, 2026
- **Other identifiers:** Other 10D1050075 (FL); Medicaid 129484600 (FL); Medicaid 129485400 (FL)
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1619504354) · Data from the CMS NPPES public registry.