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DAVITA MEDICAL GROUP
NPI 1659749943
Non-Pharmacy Dispensing Site in Brandon, FL

Active since September 03, 2015CLIA Certified · 2 labs
406 W BLOOMINGDALE AVE, BRANDON, FL 33511(813) 653-1880 Get Directions Write a Review

NPPES record last updated: August 19, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 19, 2019, Jul 21, 2017 (2 updates tracked since 2017).

About Davita Medical Group NPPES

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

DAVITA MEDICAL GROUP (NPI 1659749943) is a healthcare organization registered as a non-pharmacy dispensing site in Brandon, Florida and active in the NPI registry since September 2015. The organization holds 2 active CLIA laboratory certificates and lists John G. Liethen, Secretary, as its authorized official.

NPPES Registry Identity

NPI1659749943
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameOPTUMCARE FLORIDA, LLC
Location Address406 W BLOOMINGDALE AVEBrandon, FL 33511-7402
Mailing Address5626 Oberlin Dr, Suite 110San Diego, CA 92121-1705
Phone(813) 653-1880
Organization SubpartNo
Authorized OfficialJohn G. LiethenSecretary · (952) 205-6262
Enumeration DateSeptember 3, 2015
Last NPPES UpdateAugust 19, 20192 updates tracked since enumeration
✔ NPI 1659749943 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
License✔ Licensed in FL · ME79514
Definition
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
406 W BLOOMINGDALE AVE, Brandon, FL 33511
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Other Names 1

Doing Business AsDavita Medical Group

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Sanford Health Plan.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

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 10D0675080

Optumcare Florida LLC · Brandon, FL
Active · expires Mar 24, 2028
CLIA Number10D0675080
Laboratory TypeOther
Certificate Effective DateMarch 25, 2026
Certificate Expiration DateMarch 24, 2028
Laboratory DirectorBrunilda Nazario
Laboratory Phone(407) 258-3186
Laboratory LocationOptumcare Florida LLC1989 W Lumsden Rd, Brandon, FL 33511
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1034634

Optumcare Florida LLC · Brandon, FL
Active · expires Dec 7, 2026
CLIA Number10D1034634
Laboratory TypePhysician Office
Certificate Effective DateDecember 8, 2024
Certificate Expiration DateDecember 7, 2026
Laboratory DirectorMiriam Gomez
Laboratory Phone(407) 258-3186
Laboratory LocationOptumcare Florida LLC1082 E Brandon Blvd, Brandon, FL 33511
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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 Optumcare Florida, LLC's NPI number?

The NPI number for Optumcare Florida, LLC is 1659749943. It was assigned to this organization in the NPPES registry on September 3, 2015. The provider is doing business as Davita Medical Group.

Where is Optumcare Florida, LLC located?

Optumcare Florida, LLC is located at 406 W Bloomingdale Ave, Brandon, FL 33511. The listed phone number is (813) 653-1880.

What is Optumcare Florida, LLC's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

Does Optumcare Florida, LLC hold CLIA laboratory certificates?

Yes. 2 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 Optumcare Florida, LLC accept?

Health plans from Sanford Health Plan list Optumcare Florida, 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 Optumcare Florida, LLC was last updated on August 19, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.