Myrtle Ridge Primary Care, P.A
NPI 1619504354 · General Practice Physician · Lutz, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Myrtle Ridge Primary Care, P.A is a General Practice Physician organization in Lutz, FL (NPI 1619504354).
Provider details
- NPI number
- 1619504354
- Entity type
- Organization
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Yudaisy Mogena Padron, Owner(813) 909-7102
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
- Psychologist103T00000X
Behavioral Health & Social Service Providers
- Physician Assistant363A00000X
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 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
Mailing address
Other names (DBA / former)
- Doing business as
- Myrtle Ridge Primary Care, P.A
Registry dates
- Enumerated
- 2020-03-24
- Last updated
- 2026-01-08
- Certified
- 2026-01-08
Frequently asked questions
- What is Myrtle Ridge Primary Care, P.A's NPI number?
- Myrtle Ridge Primary Care, P.A's National Provider Identifier (NPI) is 1619504354, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Myrtle Ridge Primary Care, P.A?
- Myrtle Ridge Primary Care, P.A is classified in the NPPES registry as General Practice Physician (Allopathic & Osteopathic Physicians).
- Where is Myrtle Ridge Primary Care, P.A located?
- Myrtle Ridge Primary Care, P.A's practice location on file with NPPES is 1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548-3008.
- What is Myrtle Ridge Primary Care, P.A's phone number?
- The practice phone number listed in the NPPES registry for Myrtle Ridge Primary Care, P.A is (813) 909-7102.
- Does Myrtle Ridge Primary Care, P.A accept Medicare?
- Myrtle Ridge Primary Care, P.A is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Myrtle Ridge Primary Care, P.A?
- The authorized official listed on Myrtle Ridge Primary Care, P.A's NPPES record is Yudaisy Mogena Padron, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Myrtle Ridge Primary Care, P.A's NPI active?
- Yes — Myrtle Ridge Primary Care, P.A's NPI (1619504354) is active in the NPPES registry as of the last update on 2026-01-08.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.