EAST LAKE MEDICAL CLINIC
NPI 1790124741
Clinic/Center - Primary Care in Saint Cloud, FL
NPI Status: Active since June 21, 2013
Contact Information
4737 OLD CANOE CREEK RD
SAINT CLOUD, FL
ZIP 34769
Phone: (407) 705-3222
- Organization
- Clinic/Center
- Primary Care
- Accepts Insurance
- CLIA Number: 10D2256891
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 03-28-2026
About EAST LAKE MEDICAL CLINIC
This page provides the complete NPI Profile along with additional information for East Lake Medical Clinic, a primary care provider established in Saint Cloud, Florida operating as a Clinic/center, focusing in primary care . The healthcare provider is registered in the NPI registry with number 1790124741 assigned on June 2013. The practitioner's primary taxonomy code is 261QP2300X with license number ME114777 (FL). The provider is registered as an organization and their NPI record was last updated 12 years ago. The authorized official of this NPI record is Dr. Dustin Ly Md (President)
- NPI
- 1790124741
- Provider Name
- EAST LAKE MEDICAL CLINIC
- Entity Type
- Organization
- Location Address
- 4737 OLD CANOE CREEK RD SAINT CLOUD, FL 34769
- Location Phone
- (407) 705-3222
- Mailing Address
- 4737 OLD CANOE CREEK RD SAINT CLOUD, FL 34769
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-21-2013
- Last Update Date
- 06-21-2013
- Code Navigator
A primary care provider (PCP) like East Lake Medical Clinic sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, 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
Clinic/Center Primary Care
- Taxonomy Code
- 261QP2300X
- Type
- Ambulatory Health Care Facilities
- License No.
- ME114777
- License State
- FL
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Clear VALUE Silver - HMO
- Complete VALUE Gold - HMO
- Focused VALUE Silver - HMO
- Focused VALUE Silver + Vision + Adult Dental - HMO
- Standard Gold VALUE - HMO
- Standard Silver VALUE - HMO
- Standard Silver VALUE + Vision + Adult Dental - HMO
- Complete VALUE Gold - HMO
- Complete VALUE Silver - HMO
- Elite VALUE Bronze - HMO
- Focused VALUE Silver - HMO
- Standard Expanded Bronze VALUE - HMO
- Standard Gold VALUE - HMO
- Standard Silver VALUE - HMO
- AvMed Entrust Bronze 600 (2025) - HMO
- AvMed Entrust Bronze 650 (2025) - HMO
- AvMed Entrust Expanded Bronze Standard (2025) - HMO
- AvMed Entrust Gold 125 (2025) - HMO
- AvMed Entrust Gold 125 Dental+Vision (2025) - HMO
- AvMed Entrust Gold Standard (2025) - HMO
- AvMed Entrust Platinum 25 (2025) - HMO
- AvMed Entrust Platinum 25 Dental+Vision (2025) - HMO
- AvMed Entrust Platinum Standard (2025) - HMO
- AvMed Entrust Silver 350 (2025) - HMO
- AvMed Entrust Silver 350 Dental+Vision (2025) - HMO
- AvMed Entrust Silver 550 (2025) - HMO
- AvMed Entrust Silver 550 Dental+Vision (2025) - HMO
- AvMed Entrust Silver Standard (2025) - 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
- 10D2256891
- Facility Type
- Physician Office
- Certificate Effective Date
- March 29, 2024
- Certificate Expiration Date
- March 28, 2026
- Laboratory Director
- DUSTIN N. LY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to East Lake Medical Clinic 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 EAST LAKE MEDICAL CLINIC
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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 | 7 | 9 | 0 | 1 | 2 | 4 | 7 | 4 | 1 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 18 | 0 | 2 | 2 | 8 | 7 | 8 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 7 + 1 + 8 + 0 + 2 + 2 + 8 + 7 + 8 + 24 = 69 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 69 = 1 | 1 | ||||||||
The NPI number 1790124741 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following provider is registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1710195268 | DR. DUSTIN N LY MD Individual | Internal Medicine | 4737 OLD CANOE CREEK RD SAINT CLOUD, FL 34769 (407) 705-3222 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1790124741, enumerated in the NPI registry as an "organization" on June 21, 2013
The provider is located at 4737 Old Canoe Creek Rd Saint Cloud, Fl 34769 and the phone number is (407) 705-3222
This medical organization specializes in Clinic/Center with taxonomy code 261QP2300X with a focus in Primary Care
The provider might be accepting Accepts: Ambetter from Superior HealthPlan, Ambetter Health. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 10D2256891 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 June 21, 2013. 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.