NPIMap

Organization Active NPI

West Florida Medical Associates P a

Doing business as Bellam Medical Clinic

  • Rural Health Clinic/Center
  • Inglis, FL
National Provider Identifier
1093852931
Registry record updated Nov 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
ME0060472 Issued in FL
Legal business name
WEST FLORIDA MEDICAL ASSOCIATES P A
Doing business as
Bellam Medical Clinic
Practice address
41 N Inglis Ave
Inglis, FL 34449-9463
Phone
(352) 447-3031
NPI assigned
Jan 31, 2007
Last updated
Nov 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2010

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

Authorized official

Name
Dr. Rajendra P Bellam, M.D.
Title
President
Phone
(352) 447-3031

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X ME0060472 FL Primary

Addresses

Primary practice location

41 N Inglis Ave
Inglis, FL 34449-9463

Mailing address

PO Box 69
41 N. Inglis Ave
Inglis, FL 34449-0069
Phone (352) 447-3031

Other identifiers 1

IdentifierTypeStateIssuer
660142100MedicaidFL

Other names 1

  • Bellam Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091017000048 FL Part A Provider - Rural Health Clinic 9032023221 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Inverness, FL
O20101108001029 FL Part A Provider - Rural Health Clinic 9032023221 Practice locations: Inglis, FL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1093852931. Details of each certification follow.

Rural health clinic certification: CCN 103834

Legal name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
COMPREHENSIVE PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 17, 2010
Last certification
May 19, 2022
Ownership / control type
1A
Organization structure
CorporationProprietary
Incorporated
Jun 5, 1997 in FL
Enrollment address
213 S Pine Ave
Inverness, FL 34452-4830

Rural health clinic certification: CCN 108923

Legal name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 2000
Last certification
Sep 6, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
Jun 5, 1997 in FL
Enrollment address
41 N Inglis Ave
Inglis, FL 34449-9463

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

41 N Inglis Ave
Inglis, FL 34449
Phone (352) 447-3031

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Hasibul Hassan Khan Individual 5% Or Greater Direct Ownership Interest Jan 1, 2012 100%
W-2 Managing Employee Apr 2, 2008
Uday Hiremath Individual 5% Or Greater Direct Ownership Interest Oct 13, 2022 100%
Rajendra Bellam Individual W-2 Managing Employee Sep 1, 2010

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289260800000",
    "number": "1093852931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "address_2": "41 N. INGLIS AVE",
            "city": "INGLIS",
            "state": "FL",
            "postal_code": "344490069",
            "telephone_number": "352-447-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 N INGLIS AVE",
            "city": "INGLIS",
            "state": "FL",
            "postal_code": "344499463",
            "telephone_number": "352-447-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FLORIDA MEDICAL ASSOCIATES P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2010-11-09",
        "status": "A",
        "authorized_official_last_name": "BELLAM",
        "authorized_official_first_name": "RAJENDRA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-447-3031",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "ME0060472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660142100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bellam Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Inglis, FL

Sources for this page

Verify at the official NPI Registry.