CENTERWELL SENIOR PRIMARY CARE-BLUE DIAMOND
NPI 1043926777
Internal Medicine in Las Vegas, NV
NPI Status: Active since January 26, 2023
Contact Information
4517 BLUE DIAMOND RD
LAS VEGAS, NV
ZIP 89139
Phone: (725) 258-2982
Fax: (877) 709-4341
- Organization
- Internal Medicine
- CLIA Number: 29D2285208
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 07-06-2025
About CENTERWELL SENIOR PRIMARY CARE-BLUE DIAMOND
This page provides the complete NPI Profile along with additional information for Centerwell Senior Primary Care-blue Diamond, an internist established in Las Vegas, Nevada operating as a Internal Medicine. The healthcare provider is registered in the NPI registry with number 1043926777 assigned on January 2023. The practitioner's primary taxonomy code is 207R00000X. The provider is registered as an organization and their NPI record was last updated one year ago. Centerwell Senior Primary Care-blue Diamond operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The provider's is doing business as Centerwell Senior Primary Care-blue Diamond. The authorized official of this NPI record is Angie Martinez (Senior Credentialing Professional)
- NPI
- 1043926777
- Provider Legal Name
- CENTERWELL SENIOR PRIMARY CARE (NV) PC
- Other Organization Name
- CENTERWELL SENIOR PRIMARY CARE-BLUE DIAMOND
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 4517 BLUE DIAMOND RD LAS VEGAS, NV 89139
- Location Phone
- (725) 258-2982
- Location Fax
- (877) 709-4341
- Mailing Address
- 6101 BLUE LAGOON DR STE 200 MIAMI, FL 33126
- Mailing Phone
- (305) 500-2000
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 01-26-2023
- Last Update Date
- 07-03-2024
- Code Navigator
An internist like Centerwell Senior Primary Care-blue Diamond is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
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
Internal Medicine
- Taxonomy Code
- 207R00000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
| 2 | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | |
| 3 | 208D00000X | Allopathic & Osteopathic Physicians | General Practice |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
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
- 29D2285208
- Facility Type
- Physician Office
- Certificate Effective Date
- July 07, 2023
- Certificate Expiration Date
- July 06, 2025
- Laboratory Director
- TRACY J WAKEFIELD
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Centerwell Senior Primary Care-blue Diamond 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 Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 0 | 4 | 3 | 9 | 2 | 6 | 7 | 7 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 8 | 3 | 18 | 2 | 12 | 7 | 14 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 8 + 3 + 1 + 8 + 2 + 1 + 2 + 7 + 1 + 4 + 24 = 63 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 63 = 7 | 7 | ||||||||
The NPI number 1043926777 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 2 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1174596431 | NANCY TE LAO MD Individual | Family Medicine | 4517 BLUE DIAMOND RD LAS VEGAS, NV 89139 (725) 258-2982 |
| 1740550078 | CHESTER C. ROBERT WHITLEY IV P.A.-C Individual | Physician Assistant | 4517 BLUE DIAMOND RD LAS VEGAS, NV 89139 (725) 258-2982 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1043926777, enumerated in the NPI registry as an "organization" on January 26, 2023
The provider is located at 4517 Blue Diamond Rd Las Vegas, Nv 89139 and the phone number is (725) 258-2982
This medical organization specializes in Internal Medicine with taxonomy code 207R00000X
The provider's CLIA number is 29D2285208 for a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued 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..
This NPI record was last updated on January 26, 2023. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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