East Lake Medical Clinic
NPI 1790124741 · Primary Care Clinic/Center · Saint Cloud, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
East Lake Medical Clinic is a Primary Care Clinic/Center organization in Saint Cloud, FL (NPI 1790124741).
Provider details
- NPI number
- 1790124741
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Dustin Ly, President(407) 705-3222
- License
- ME114777 (FL)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 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
Registry dates
- Enumerated
- 2013-06-21
- Last updated
- 2013-06-21
Frequently asked questions
- What is East Lake Medical Clinic's NPI number?
- East Lake Medical Clinic's National Provider Identifier (NPI) is 1790124741, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is East Lake Medical Clinic?
- East Lake Medical Clinic is classified in the NPPES registry as Primary Care Clinic/Center (Ambulatory Health Care Facilities).
- Where is East Lake Medical Clinic located?
- East Lake Medical Clinic's practice location on file with NPPES is 4737 Old Canoe Creek Rd, Saint Cloud, FL 34769-1400.
- What is East Lake Medical Clinic's phone number?
- The practice phone number listed in the NPPES registry for East Lake Medical Clinic is (407) 705-3222.
- Does East Lake Medical Clinic accept Medicare?
- East Lake Medical Clinic 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 East Lake Medical Clinic?
- The authorized official listed on East Lake Medical Clinic's NPPES record is Dustin Ly, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is East Lake Medical Clinic's NPI active?
- Yes — East Lake Medical Clinic's NPI (1790124741) is active in the NPPES registry as of the last update on 2013-06-21.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.