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DAVITA MEDICAL GROUP
NPI 1972663102
Pharmacy - Community/Retail Pharmacy in St Petersburg, FL

Active since December 11, 2006CLIA Certified · 5 labs
7601 9TH ST N, STE C 1, ST PETERSBURG, FL 33702(727) 520-7995(727) 520-7963 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 1972663102) is a healthcare organization registered as a community/retail pharmacy in St Petersburg, Florida and active in the NPI registry since December 2006. The organization holds 5 active CLIA laboratory certificates and lists John G. Liethen, Secretary, as its authorized official.

NPPES Registry Identity

NPI1972663102
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameOPTUMCARE FLORIDA LLC
Location Address7601 9TH ST N, STE C 1St Petersburg, FL 33702-5211
Mailing Address10051 5th Street N.St Petersburg, FL 33702 · (727) 520-7995 · Fax (727) 520-7963
Phone(727) 520-7995
Fax(727) 520-7963
Organization SubpartNo
Authorized OfficialJohn G. LiethenSecretary · (952) 205-6262
Enumeration DateDecember 11, 2006
Last NPPES UpdateAugust 19, 20192 updates tracked since enumeration
✔ NPI 1972663102 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in FL · PH19244
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Also ListedPharmacyTaxonomy 333600000X
7601 9TH ST N, St Petersburg, FL 33702
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Other Names 1

Doing Business AsDavita Medical Group

Other Identifiers 2

Medicaid030938900FL
Other2015674Pk

CLIA Laboratory Certificates CMS CLIA 5

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 10D1000411

Optumcare Florida LLC · Saint Petersburg, FL
Active · expires Jun 16, 2028
CLIA Number10D1000411
Laboratory TypePhysician Office
Certificate Effective DateJune 17, 2026
Certificate Expiration DateJune 16, 2028
Laboratory DirectorLyndon Soe
Laboratory Phone(407) 258-3186
Laboratory LocationOptumcare Florida LLC4901 34th St S, Saint Petersburg, FL 33711
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2101884

Optumcare Florida LLC · Saint Petersburg, FL
Active · expires Sep 10, 2027
CLIA Number10D2101884
Laboratory TypePhysician Office
Certificate Effective DateSeptember 11, 2025
Certificate Expiration DateSeptember 10, 2027
Laboratory DirectorAngelino V. Michael
Laboratory Phone(407) 258-3186
Laboratory LocationOptumcare Florida LLC7655 38th Ave N Ste 101, Saint Petersburg, FL 33710
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1042909

Optumcare Florida LLC · Saint Petersburg, FL
Active · expires Jul 11, 2027
CLIA Number10D1042909
Laboratory TypePhysician Office
Certificate Effective DateJuly 12, 2025
Certificate Expiration DateJuly 11, 2027
Laboratory DirectorBryan Parmer
Laboratory Phone(407) 258-3186
Laboratory LocationOptumcare Florida LLC3328 49th St North Ste A, Saint Petersburg, FL 33710
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2046974

Optumcare Florida LLC · Saint Petersburg, FL
Active · expires Sep 13, 2026
CLIA Number10D2046974
Laboratory TypePhysician Office
Certificate Effective DateSeptember 14, 2024
Certificate Expiration DateSeptember 13, 2026
Laboratory DirectorAshleyrae Donald
Laboratory Phone(407) 258-3186
Laboratory LocationOptumcare Florida LLC2812 54th Ave S, Saint Petersburg, FL 33712
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D0720970

Optumcare Florida LLC · Saint Petersburg, FL
Active · expires Aug 31, 2026
CLIA Number10D0720970
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorDerek Hiltz
Laboratory Phone(727) 343-6119
Laboratory LocationOptumcare Florida LLC508 Pasadena Ave S, Saint Petersburg, FL 33707
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 1972663102. It was assigned to this organization in the NPPES registry on December 11, 2006. The provider is doing business as Davita Medical Group.

Where is Optumcare Florida LLC located?

Optumcare Florida LLC is located at 7601 9th St N Ste C 1, St Petersburg, FL 33702. The listed phone number is (727) 520-7995.

What is Optumcare Florida LLC's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Optumcare Florida LLC hold CLIA laboratory certificates?

Yes. 5 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.

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.