DAVITA MEDICAL GROUP
NPI 1659749943
Non-Pharmacy Dispensing Site in Brandon, FL
NPI Status: Active since September 03, 2015
Contact Information
406 W BLOOMINGDALE AVE
BRANDON, FL
ZIP 33511
Phone: (813) 653-1880
- Organization
- Non-Pharmacy Dispensing Site
- Accepts Insurance
- CLIA Number: 10D0696030
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-31-2026
About DAVITA MEDICAL GROUP
This page provides the complete NPI Profile along with additional information for Davita Medical Group, a provider established in Brandon, Florida operating as a Non-pharmacy Dispensing Site. The healthcare provider is registered in the NPI registry with number 1659749943 assigned on September 2015. The practitioner's primary taxonomy code is 332900000X with license number ME79514 (FL). The provider is registered as an organization and their NPI record was last updated 7 years ago. The provider's is doing business as Davita Medical Group. The authorized official of this NPI record is John G. Liethen (Secretary)
- NPI
- 1659749943
- Provider Legal Name
- OPTUMCARE FLORIDA, LLC
- Other Organization Name
- DAVITA MEDICAL GROUP
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 406 W BLOOMINGDALE AVE BRANDON, FL 33511
- Location Phone
- (813) 653-1880
- Mailing Address
- 5626 OBERLIN DR SUITE 110 SAN DIEGO, CA 92121
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-03-2015
- Last Update Date
- 08-19-2019
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Non-Pharmacy Dispensing Site
- Taxonomy Code
- 332900000X
- Type
- Suppliers
- License No.
- ME79514
- License State
- FL
- Taxonomy Description
- 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.)
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Sanford Individual Simplicity $1,750 - PPO
- Sanford Individual Simplicity $10,600 - PPO
- Sanford Individual Simplicity $3,500 - PPO
- Sanford Individual Simplicity $4,750 - PPO
- Sanford Individual Simplicity $6,500 - PPO
- Sanford Individual Simplicity $7,200 HSA Qualified - PPO
- Sanford Individual Simplicity Standardized $2,000 - PPO
- Sanford Individual Simplicity Standardized $6,000 - PPO
- Sanford Individual Simplicity Standardized $7,500 - PPO
- Sanford Individual TRUE $1,750 - HMO
- Sanford Individual TRUE $10,600 - HMO
- Sanford Individual TRUE $3,500 - HMO
- Sanford Individual TRUE $4,750 - HMO
- Sanford Individual TRUE $6,500 - HMO
- Sanford Individual TRUE $7,200 HSA Qualified - HMO
- Sanford Individual TRUE Standardized $2,000 - HMO
- Sanford Individual TRUE Standardized $6,000 - HMO
- Sanford Individual TRUE Standardized $7,500 - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 10D0696030
- Facility Type
- Physician Office
- Certificate Effective Date
- September 01, 2024
- Certificate Expiration Date
- August 31, 2026
- Laboratory Director
- JOLLY JOSE
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Davita Medical Group to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1659749943, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 77. The final step is to find the difference between that total and the next multiple of ten (80 - 77 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 77 is 80. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1659749943, enumerated as an "organization" on September 03, 2015.
The provider is located at 406 W BLOOMINGDALE AVE BRANDON, FL 33511 and the phone number is (813) 653-1880.
Non-Pharmacy Dispensing Site with taxonomy code 332900000X.
The provider might be accepting Accepts: Sanford Health Plan. Please consult your insurance carrier or call the provider to verify.
