OrganizationActive
Medical Pavilion Clinc
NPI 1063671683 · Preferred Provider Organization · Port Charlotte, FL
Provider details
- NPI number
- 1063671683
- Entity type
- Organization
- Primary specialty
- Preferred Provider OrganizationManaged Care Organizations
- Organization subpart
- No
- Authorized official
- David Ballestas, Doctor - Owner(941) 629-9190
- License
- ME0044391 (FL)
Specialties & taxonomies
Managed Care Organizations
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2525 Harbor Blvd
Suite 102
Port Charlotte, FL 33952-5317
Phone: (941) 629-9190
Fax: (941) 625-2751
Street-level locationGet directions
Mailing address
2525 Harbor Blvd
Port Charlotte, FL 33952-5317
Registry dates
- Enumerated
- 2008-06-09
- Last updated
- 2008-06-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.