EAST LAKE MEDICAL CLINIC
NPI 1790124741
Clinic/Center - Primary Care in Saint Cloud, FL

Q: What is East Lake Medical Clinic's NPI number?

The NPI number for East Lake Medical Clinic is 1790124741. It was assigned to this organization in the NPPES registry on June 21, 2013.

Q: What is East Lake Medical Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Active since June 21, 2013CLIA Certified · 2 labs

4737 OLD CANOE CREEK RD, SAINT CLOUD, FL 34769(407) 705-3222 Get Directions Write a Review

NPPES record last updated: June 21, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About East Lake Medical Clinic NPPES

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

EAST LAKE MEDICAL CLINIC (NPI 1790124741) is a healthcare organization registered as a primary care in Saint Cloud, Florida and active in the NPI registry since June 2013. The organization holds 2 active CLIA laboratory certificates and lists Dustin Ly, President, as its authorized official.

NPPES Registry Identity

NPI1790124741

Entity TypeOrganization

Primary Taxonomy261QP2300X

Legal Business NameEAST LAKE MEDICAL CLINIC

Location Address4737 OLD CANOE CREEK RDSaint Cloud, FL 34769-1400

Mailing Address4737 Old Canoe Creek RdSaint Cloud, FL 34769-1400

Phone(407) 705-3222

Organization SubpartNo

Authorized OfficialDustin LyPresident · (407) 705-3222

Enumeration DateJune 21, 2013

✔ NPI 1790124741 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities

Taxonomy Code261QP2300X

License✔ Licensed in FL · ME114777

4737 OLD CANOE CREEK RD, Saint Cloud, FL 34769

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Ambetter of Alabama and more.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 10D2067792

East Lake Medical Clinic PLLC · Saint Cloud, FL

Active · expires Oct 22, 2027

CLIA Number10D2067792

Laboratory TypePhysician Office

Certificate Effective DateOctober 23, 2025

Certificate Expiration DateOctober 22, 2027

Laboratory DirectorDustin Ly

Laboratory Phone(407) 705-3222

Laboratory LocationEast Lake Medical Clinic PLLC4737 Old Canoe Creek Rd, Saint Cloud, FL 34769

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2256891

East Lake Medical Clinic PA · Orlando, FL

Active · expires Mar 28, 2028

CLIA Number10D2256891

Laboratory TypePhysician Office

Certificate Effective DateMarch 29, 2026

Certificate Expiration DateMarch 28, 2028

Laboratory DirectorDustin N. Ly

Laboratory Phone(407) 705-3222

Laboratory LocationEast Lake Medical Clinic PA4361 Hunters Park Ln, Orlando, FL 32837

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

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

DR. DUSTIN N LY MD

Internal Medicine

4737 OLD CANOE CREEK RD
SAINT CLOUD, FL 34769

Osceola County (407) 705-3222

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 East Lake Medical Clinic's NPI number?

The NPI number for East Lake Medical Clinic is 1790124741. It was assigned to this organization in the NPPES registry on June 21, 2013.

Where is East Lake Medical Clinic located?

East Lake Medical Clinic is located at 4737 Old Canoe Creek Rd, Saint Cloud, FL 34769. The listed phone number is (407) 705-3222.

What is East Lake Medical Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does East Lake Medical Clinic 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 East Lake Medical Clinic accept?

Health plans from Ambetter Health, Ambetter from Superior HealthPlan, Ambetter of Alabama and AvMed list East Lake Medical Clinic 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 East Lake Medical Clinic was last updated on June 21, 2013. NPI Profile syncs with the weekly NPPES data releases published by CMS.