Organization Active NPI

Hernando Medical Inc

  • Internal Medicine Physician
  • Brooksville, FL
National Provider Identifier
1023080629
Registry record updated Dec 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME78544 Issued in FL
Legal business name
HERNANDO MEDICAL INC
Practice address
12900 Cortez Blvd
Ste 202
Brooksville, FL 34613
Phone
(352) 597-8844
Fax
(352) 597-8831
NPI assigned
Feb 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mohammad A Joud, M.D.NPI 1578513313
Title
President Owner
Phone
(352) 597-8844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X ME78544 FL Primary

Addresses

Primary practice location

12900 Cortez Blvd
Ste 202
Brooksville, FL 34613

Mailing address

12900 Cortez Blvd
Ste 202
Brooksville, FL 34613
Phone (352) 597-8844

Other identifiers 1

IdentifierTypeStateIssuer
258942700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013000790 FL Part B Supplier - Clinic/Group Practice 5698735793 Receives reassigned benefits from 1 practitioner
Practice locations: Brooksville, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2160950Hernando Medical Inc12900 Cortez Blvd Ste 202, Brooksville, FL 34613Certificate of waiverJan 22, 2027

National Provider Directory

National Provider Directory

Locations

12900 Cortez Blvd
Ste 202
Brooksville, FL 34613
Phone (352) 597-8844

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260316800000",
    "number": "1023080629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12900 CORTEZ BLVD",
            "address_2": "STE 202",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "34613",
            "telephone_number": "352-597-8844",
            "fax_number": "352-597-8831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12900 CORTEZ BLVD",
            "address_2": "STE 202",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "34613",
            "telephone_number": "352-597-8844",
            "fax_number": "352-597-8831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERNANDO MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2009-12-09",
        "status": "A",
        "authorized_official_last_name": "JOUD",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "352-597-8844",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME78544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "258942700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooksville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; 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.

Verify at the official NPI Registry.