ULTIMATE MEDICAL CLINIC LLC
NPI 1922692003
Clinic/Center - Primary Care in Debary, FL
About Ultimate Medical Clinic Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ULTIMATE MEDICAL CLINIC LLC (NPI 1922692003) is a healthcare organization registered as a primary care in Debary, Florida and active in the NPI registry since March 2021. The organization holds a CLIA Waiver certificate valid through May 13, 2027 and lists Jamie Grainger, Owner/chiropractor, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ultimate Medical Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Ultimate Medical Clinic LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
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 10D2224663
Ultimate Medical Clinic · Debary, 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 Ultimate Medical Clinic LLC's NPI number?
The NPI number for Ultimate Medical Clinic LLC is 1922692003. It was assigned to this organization in the NPPES registry on March 1, 2021.
Where is Ultimate Medical Clinic LLC located?
Ultimate Medical Clinic LLC is located at 70 Fox Ridge Ct Ste A, Debary, FL 32713. The listed phone number is (386) 668-6321.
What is Ultimate Medical Clinic LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Ultimate Medical Clinic LLC enrolled in Medicare?
Yes. Ultimate Medical Clinic LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Ultimate Medical Clinic LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Ultimate Medical Clinic LLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Ultimate Medical Clinic LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 10D2224663) is associated with this NPI, valid through May 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Ultimate Medical Clinic LLC was last updated on March 1, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Ultimate Medical Clinic Llc · NPI 1922692003
Primary Care organization in Debary, Florida. Organization record, active in the CMS NPPES registry since March 1, 2021.
## Identity
- **NPI:** 1922692003 (Entity type: Organization)
- **Enumerated:** March 1, 2021
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** Yes (part of Debary Chiropractic Center Corp)
- **Authorized official:** Jamie Grainger, OWNER/CHIROPRACTOR
## Practice location
- **Address:** 70 FOX RIDGE CT STE A, Debary, FL 32713-2752
- **Phone:** (386) 668-6321
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 1, 2021
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1922692003) · Data from the CMS NPPES public registry.