Myrtle Ridge Primary Care, P.A
NPI 1619504354ActiveOrganization· General Practice· Lutz, FL
General Practice in Lutz, Florida, registered in NPPES in March 2020. The authorized official on file is Yudaisy Mogena Padron, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1619504354 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 24, 2020 |
| Last updated in NPPES | Jan 8, 2026 |
| Certified by provider | Jan 8, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| General Practice Primary | 208D00000X | — | — |
| Counselor, Mental Health | 101YM0800X | — | — |
| Psychologist | 103T00000X | — | — |
| Physician Assistant | 363A00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (FL) |
|---|
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