Individual provider Active NPI

Basant M Farghaly, M.D.

  • Family Medicine Physician
  • St Augustine, FL
National Provider Identifier
1104945872
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME97900 Issued in FL
Practice address
3100 US Highway 1 S Ste 4
St Augustine, FL 32086-6310
Phone
(904) 810-8063
Fax
(904) 621-9230
NPI assigned
Mar 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME97900 FL Primary

Addresses

Primary practice location

3100 US Highway 1 S Ste 4
St Augustine, FL 32086-6310

Mailing address

3300 S Fiske Blvd
Rockledge, FL 32955-4306
Phone (904) 810-8063

Other identifiers 2

IdentifierTypeStateIssuer
278175100MedicaidFL
PW879OtherFLMEDICARE HF

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070815000102 FL Practitioner - Family Practice 8921190315 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Health First Privia Medical GroupGroup PAC ID 3173965993, 247 clinicians

Practice addresses (Care Compare)

3100 US Hwy 1 S
Suite 4
St Augustine, FL 32086-6310
Phone (770) 312-5226

Hospital & facility affiliations

  • Bravery Home Healthcare Home health agency, St Augustine, FL, CCN 687344
  • Trilogy Home Healthcare Home health agency, Jacksonville, FL, CCN 107689
  • Flagler Hospital Hospital, Saint Augustine, FL, CCN 100090
  • AdventHealth Palm Coast Hospital, Palm Coast, FL, CCN 100118
  • Adventhealth Palm Coast Parkway Hospital, Palm Coast, FL, CCN 100363
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088

Merit-based Incentive Payment System (MIPS)

Final score
94.79 of 100Reported as apm
Quality
86.5
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME97900FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Florida, LLC CurrentSince Jan 1, 2025 Accepting new patients
Omar Medical PLLC Past Accepting new patients

Locations

140 6th Ave
Indialantic, FL 32903
Phone (321) 312-3501

3300 S Fiske Blvd
Rockledge, FL 32955
Phone (321) 434-1771

989 Sebastian Blvd
Unit 3
Sebastian, FL 32958
Phone (727) 617-1777

3100 US Highway 1 S
Ste 4
St Augustine, FL 32086
Phone (904) 810-8063

9332 State Road 54
Ste 403
Trinity, FL 34655
Phone (727) 376-1536

Interoperability endpoints

  • Direct secure messaging: basant.farghaly.1@8042.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1104945872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306",
            "telephone_number": "904-810-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 US HIGHWAY 1 S STE 4",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866310",
            "telephone_number": "904-810-8063",
            "fax_number": "904-621-9230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARGHALY",
        "first_name": "BASANT",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME97900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278175100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE HF",
            "identifier": "PW879",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.