1. Home
  2. Directory
  3. Florida
  4. Tampa
  5. Clinic Center
  6. NPI Profile

CARROLLWOOD MEDICAL GROUP, LLC.
NPI 1982150348
Clinic/Center in Tampa, FL

Active since August 26, 2016CLIA 10D2118999 · Waiver
10213 LAKE CARROLL WAY STE B, TAMPA, FL 33618(813) 888-8215(813) 885-5398 Get Directions Write a Review

NPPES record last updated: February 10, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Feb 10, 2025, Dec 2, 2024, Aug 26, 2016 (3 updates tracked since 2016).

About Carrollwood Medical Group, Llc. NPPES

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

CARROLLWOOD MEDICAL GROUP, LLC. (NPI 1982150348), doing business as Revello Medical Center, is a healthcare organization registered as a clinic/center in Tampa, Florida and active in the NPI registry since August 2016. The organization holds a CLIA Waiver certificate valid through September 18, 2028 and lists Antonio Calvo, Coo, as its authorized official.

NPPES Registry Identity

NPI1982150348
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameCARROLLWOOD MEDICAL GROUP, LLC.
Location Address10213 LAKE CARROLL WAY STE BTampa, FL 33618-4402
Mailing Address5901 Webb RdTampa, FL 33615-3219 · (813) 888-8215 · Fax (813) 885-5398
Phone(813) 888-8215
Fax(813) 885-5398
Organization SubpartNo
Authorized OfficialAntonio CalvoCoo · (813) 888-8215
Enumeration DateAugust 26, 2016
Last NPPES UpdateFebruary 10, 20253 updates tracked since enumeration
NPPES CertifiedFebruary 10, 2025
✔ NPI 1982150348 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
10213 LAKE CARROLL WAY STE B, Tampa, FL 33618
Open in Google Maps ↗

Other Names 1

Doing Business AsRevello Medical Center

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Carrollwood Medical Group, Llc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Carrollwood Medical Group, LLC., which bills Medicare for the services this clinician delivers.

Clinician (1)

Lazaro Perez, FNP
Nurse Practitioner
NPI 1841022050
5901 WEBB RD
Tampa, FL 33615
(813) 888-8215
✔ PECOS5.2 mi

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 10D2118999

Carrollwood Medical Group · Tampa, FL
Active · expires Sep 18, 2028
CLIA Number10D2118999
Laboratory TypePhysician Office
Certificate Effective DateSeptember 19, 2026
Certificate Expiration DateSeptember 18, 2028
Laboratory DirectorPatricia Rodriguez
Laboratory Phone(813) 888-8215
Laboratory LocationCarrollwood Medical Group10213 Lake Carroll Way Ste D, Tampa, FL 33615
CLIA data matches this NPI record on: Name Phone
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 Carrollwood Medical Group, LLC.'s NPI number?

The NPI number for Carrollwood Medical Group, LLC. is 1982150348. It was assigned to this organization in the NPPES registry on August 26, 2016. The provider is doing business as Revello Medical Center.

Where is Carrollwood Medical Group, LLC. located?

Carrollwood Medical Group, LLC. is located at 10213 Lake Carroll Way Ste B, Tampa, FL 33618. The listed phone number is (813) 888-8215.

What is Carrollwood Medical Group, LLC.'s specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is Carrollwood Medical Group, LLC. enrolled in Medicare?

Yes. Carrollwood Medical Group, LLC. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Carrollwood Medical Group, LLC.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Carrollwood Medical Group, 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Carrollwood Medical Group, LLC. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2118999) is associated with this NPI, valid through September 18, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Carrollwood Medical Group, LLC. was last updated on February 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months 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.