Active NPI
Maa Bhawani Inc
- Community/Retail Pharmacy
- Homosassa, FL
National Provider Identifier
1003104779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PH25878
- Legal business name
- MAA BHAWANI INC
- Practice address
- 5691 S Suncoast Blvd
Homosassa, FL 34446-2605 - Phone
- (352) 628-0096
- Fax
- (352) 527-2629
- NPI assigned
- Jul 15, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Rajesh Patel, PHARM D
- Title
- Owner/President
- Phone
- (352) 527-3111
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PH25878 | FL | Primary |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
5691 S Suncoast Blvd
Homosassa, FL 34446-2605
Mailing address
3791 N Lecanto Hwy
Beverly Hills, FL 34465-3559
Phone (352) 527-3111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2133257 | Other | PK |
Other names 1
- G & R HEALTH MART #2
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200522001311 | FL | DME Supplier - Pharmacy | 3274732805 | Practice locations: Homosassa, FL |
| O20200526002944 | FL | Part B Supplier - Pharmacy | 3274732805 | Practice locations: Homosassa, FL |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2193296 | G & R Health Mart Pharmacy | Certificate of waiver | Sep 17, 2026 |
National Provider Directory
National Provider Directory- Tax ID family
- Maa Bhawani Inc
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Beverly Hills, FL
- NPI 1174775365
-
- Long Term Care Pharmacy
- Homosassa, FL
- NPI 1740120617
-
- Long Term Care Pharmacy
- Beverly Hills, FL
- NPI 1831735406
-
- Long Term Care Pharmacy
- Beverly Hills, FL
- NPI 1912542002
Locations
5691 S Suncoast Blvd
#G
Homosassa, FL 34446
Phone (352) 628-0096
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Registered Nurse
- Homosassa, FL
- NPI 1174187413
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310688000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1488240000000",
"number": "1003104779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3791 N LECANTO HWY",
"city": "BEVERLY HILLS",
"state": "FL",
"postal_code": "344653559",
"telephone_number": "352-527-3111",
"fax_number": "352-527-2629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5691 S SUNCOAST BLVD",
"city": "HOMOSASSA",
"state": "FL",
"postal_code": "344462605",
"telephone_number": "352-628-0096",
"fax_number": "352-527-2629"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAA BHAWANI INC",
"organizational_subpart": "NO",
"enumeration_date": "2011-07-15",
"last_updated": "2017-02-28",
"status": "A",
"authorized_official_last_name": "PATEL",
"authorized_official_first_name": "RAJESH",
"authorized_official_title_or_position": "OWNER/PRESIDENT",
"authorized_official_telephone_number": "352-527-3111",
"authorized_official_credential": "PHARM D"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "FL",
"license": "PH25878",
"primary": true
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2133257",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "G & R HEALTH MART #2",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Homosassa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.