NPIMap

Organization Active NPI

West Florida Medical Associates P a

Doing business as Hernando Medical Clinic

  • Rural Health Clinic/Center
  • Hernando, FL
National Provider Identifier
1164560124
Registry record updated Oct 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
ME0050533 Issued in FL
Legal business name
WEST FLORIDA MEDICAL ASSOCIATES P A
Doing business as
Hernando Medical Clinic
Practice address
2669 N Florida Ave
Hernando, FL 34442
Phone
(352) 637-2550
Fax
(352) 637-2551
NPI assigned
Feb 2, 2007
Last updated
Oct 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2010

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

Authorized official

Name
Dr. Shirishkumar G Patel, MD
Title
Physician
Phone
(352) 637-2550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X ME0050533 FL Primary

Addresses

Primary practice location

2669 N Florida Ave
Hernando, FL 34442

Mailing address

PO Box 640573
Beverly Hills, FL 34464-0573
Phone (352) 746-1558

Other names 1

  • Hernando Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101012000837 FL Part A Provider - Rural Health Clinic 9032023221 Practice locations: Hernando, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164560124. Details of each certification follow.

Rural health clinic certification: CCN 103969

Legal name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
HERNANDO MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 23, 1997
Last certification
Sep 6, 2023
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jun 5, 1997 in FL
Enrollment address
2669N Florida Ave
Hernando, FL 34442-4331

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

National Provider Directory

National Provider Directory
Tax ID family
West FL Medical Assoc L28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Uday Hiremath Individual 5% Or Greater Direct Ownership Interest Oct 13, 2022 100%
Shirishkuma G Patel Individual W-2 Managing EmployeeAdministrator Jun 5, 1997

Owners & managing parties with NPI records 1

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": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286841600000",
    "number": "1164560124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640573",
            "city": "BEVERLY HILLS",
            "state": "FL",
            "postal_code": "344640573",
            "telephone_number": "352-746-1558",
            "fax_number": "352-746-3838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2669 N FLORIDA AVE",
            "city": "HERNANDO",
            "state": "FL",
            "postal_code": "34442",
            "telephone_number": "352-637-2550",
            "fax_number": "352-637-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FLORIDA MEDICAL ASSOCIATES P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2010-10-12",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "SHIRISHKUMAR",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "352-637-2550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "ME0050533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hernando Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hernando, FL

Sources for this page

Verify at the official NPI Registry.