CENTERWELL SENIOR PRIMARY CARE (NV) PC SOS Verified
3129 N RAINBOW BLVD, LAS VEGAS, NV 89108
NPI Number
1184247579
Practice location · View on Google Maps
SOS Verification: Verified
Entity Name: CenterWell Senior Primary Care (NV), P.C.
Entity Number: E6300802020-4
Entity Type: Foreign Corporation
Entity Status: Active
Formation Date: 2020-04-29
Status Changed: 2020-04-29
Name Match: 95%
Registered Agent
Name: C T CORPORATION SYSTEM**
Type: Commercial Registered Agent
Address: 701 S CARSON ST STE 200, Carson City, NV, 89701
Officers / Principals
| Title | Name | Address | Status |
|---|---|---|---|
| President | Tina Anne Marie Kokab Shenouda, M.D. | 500 West Main Street, Louisville, KY | Inactive |
| Secretary | Tina Anne Marie Kokab Shenouda, M.D. | 500 West Main Street, Louisville, KY | Inactive |
| Treasurer | Tina Anne Marie Kokab Shenouda, M.D. | 500 West Main Street, Louisville, KY | Inactive |
| Director | Tina Anne Marie Kokab Shenouda, M.D. | 500 West Main Street, Louisville, KY | Inactive |
| Other | Donald Robinson | 500 West Main Street, Louisville, KY | Inactive |
| President | Brienne Loy, M.D. | 500 West Main Street, Louisville, KY | Inactive |
| Director | Brienne Loy, M.D. | 500 West Main Street, Louisville, KY | Inactive |
| Other | Donald Robinson | 500 West Main Street, Louisville, KY | Inactive |
| Other | Joseph Ruschell | 500 West Main Street, Louisville, KY | Inactive |
| President | Brienne Loy, M.D. Tina Anne Marie Kokab | 500 West Main Street, Louisville, KY | Inactive |
| Director | Brienne Loy, M.D. Tina Anne Marie Kokab | 500 West Main Street, Louisville, KY | Inactive |
| Treasurer | Brienne Loy, M.D. Tina Anne Marie Kokab | 500 West Main Street, Louisville, KY | Inactive |
| President | Erica Savage-Jeter, M.D | 500 West Main Street, Louisville, KY | Inactive |
| Secretary | Erica Savage-Jeter, M.D | 500 West Main Street, Louisville, KY | Inactive |
| Treasurer | Erica Savage-Jeter, M.D | 500 West Main Street, Louisville, KY | Inactive |
| President | Erica Savage-Jeter,M.D. | 101 E. Main St., Louisville, KY | Active |
| Secretary | Erica Savage-Jeter, M.D | 101 E. Main St., Louisville, KY | Active |
| Treasurer | Erica Savage-Jeter, M.D | 101 E. Main St., Louisville, KY | Active |
Payments by Year
How much Medicaid paid this provider each year. Large jumps can indicate changes in practice volume or billing patterns.
| Year | Total Paid | % of Max |
|---|---|---|
| 2024 | $0 |
Procedure Code Breakdown
The specific medical services this provider billed Medicaid for. Each HCPCS/CPT code represents a different type of visit, test, or treatment.
| HCPCS Code | Description | Claims | Paid | % of Total | Avg per Claim |
|---|---|---|---|---|---|
| 1159F | Medical service or procedure | 14 | $0 | 0.0% | $0 |
| 1126F | Medical service or procedure | 16 | $0 | 0.0% | $0 |