DAVITA MEDICAL GROUP
NPI 1780051714
Non-Pharmacy Dispensing Site in Palmetto, FL
NPI Status: Active since August 25, 2015
- Organization
- Non-Pharmacy Dispensing Site
- Accepts Insurance
- CLIA Number: 10D1034432
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-01-2026
About DAVITA MEDICAL GROUP
This page provides the complete NPI Profile along with additional information for Davita Medical Group, a provider established in Palmetto, Florida operating as a Non-pharmacy Dispensing Site. The healthcare provider is registered in the NPI registry with number 1780051714 assigned on August 2015. The practitioner's primary taxonomy code is 332900000X with license number ME87898 (FL). The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as Davita Medical Group. The authorized official of this NPI record is John G. Liethen (Secretary)
- NPI
- 1780051714
- Provider Legal Name
- OPTUMCARE FLORIDA, LLC
- Other Organization Name
- DAVITA MEDICAL GROUP
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 931 10TH ST E PALMETTO, FL 34221
- Location Phone
- (941) 847-7903
- Mailing Address
- 10051 5TH STREET N. ST. PETERSBURG, FL 33702
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 08-25-2015
- Last Update Date
- 08-19-2019
- Code Navigator
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
Non-Pharmacy Dispensing Site
- Taxonomy Code
- 332900000X
- Type
- Suppliers
- License No.
- ME87898
- License State
- FL
- Taxonomy Description
- A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BSW Elite Gold HMO 001 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
- BSW Elite Gold HMO 004 (Two free PCP visits, $0 Pediatric PCP visits) - HMO
- BSW Elite Gold HMO 012 - HMO
- BSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
- BSW Prime Silver HMO 008 (Two free PCP visits, $0 Pediatric PCP visit) - HMO
- BSW Prime Silver HMO 005 - HMO
- BSW Savers Bronze HMO H S A 006 - HMO
- BSW Vital Bronze HMO 007 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
- BSW Vital Bronze HMO 009 (One free PCP visit, $0 Pediatric PCP visit) - HMO
- Sanford Individual Simplicity $1,750 - PPO
- Sanford Individual Simplicity $3,500 - PPO
- Sanford Individual Simplicity $4,750 - PPO
- Sanford Individual Simplicity $6,000 - PPO
- Sanford Individual Simplicity $7,100 HSA Qualified - PPO
- Sanford Individual Simplicity $9,200 - PPO
- Sanford Individual Simplicity Standardized $1,500 - PPO
- Sanford Individual Simplicity Standardized $5,000 - PPO
- Sanford Individual Simplicity Standardized $7,500 - PPO
- Sanford Individual TRUE $1,750 - HMO
- Sanford Individual TRUE $3,500 - HMO
- Sanford Individual TRUE $4,750 - HMO
- Sanford Individual TRUE $6,000 - HMO
- Sanford Individual TRUE $7,100 HSA Qualified - HMO
- Sanford Individual TRUE $9,200 - HMO
- Sanford Individual TRUE Standardized $1,500 - HMO
- Sanford Individual TRUE Standardized $5,000 - HMO
- Sanford Individual TRUE Standardized $7,500 - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
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
- 10D1034432
- Facility Type
- Physician Office
- Certificate Effective Date
- December 02, 2024
- Certificate Expiration Date
- December 01, 2026
- Laboratory Director
- SUZANNE JOHNSON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Davita Medical Group 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.
Reviews for DAVITA MEDICAL GROUP
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
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 | 7 | 8 | 0 | 0 | 5 | 1 | 7 | 1 | 4 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 16 | 0 | 0 | 5 | 2 | 7 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 7 + 1 + 6 + 0 + 0 + 5 + 2 + 7 + 2 + 24 = 56 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 56 = 4 | 4 | ||||||||
The NPI number 1780051714 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 3 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1558325266 | MICHAEL D BURDAY MD Individual | Internal Medicine | 931 10TH ST E PALMETTO, FL 34221 (941) 847-7903 |
| 1891933800 | DR. SANTOSH KAMATH M.D. Individual | Internal Medicine | 931 10TH ST E PALMETTO, FL 34221 (941) 933-8103 |
| 1720288509 | OLGA KUCHMAK MD Individual | Internal Medicine | 931 10TH ST E PALMETTO, FL 34221 (941) 933-8103 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1780051714, enumerated in the NPI registry as an "organization" on August 25, 2015
The provider is located at 931 10th St E Palmetto, Fl 34221 and the phone number is (941) 847-7903
This medical organization specializes in Non-Pharmacy Dispensing Site with taxonomy code 332900000X
The provider might be accepting Accepts: Baylor Scott and White Health Plan and Sanford. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 10D1034432 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 August 25, 2015. 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].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.