NPIMap

Organization Active NPI

Rizwana Thanawala MD PA

  • Gastroenterology Physician
  • Lake City, FL
National Provider Identifier
1194945097
Registry record updated Jan 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
RIZWANA THANAWALA MD PA
Practice address
4367 NW American LN
Lake City, FL 32055-4828
Phone
(386) 758-6094
Fax
(386) 758-6995
NPI assigned
Apr 26, 2007
Last updated
Jan 31, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2011

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

Authorized official

Name
Rizwana Thanawala, M.DNPI 1922082833
Title
Owner
Phone
(386) 758-6094

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
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

4367 NW American LN
Lake City, FL 32055-4828

Mailing address

4367 NW American Lane
Lake City, FL 32055-4828
Phone (386) 758-6094

Other identifiers 2

IdentifierTypeStateIssuer
74502OtherFLBCBS GROUP ID
266910200MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040519001662 FL Part B Supplier - Clinic/Group Practice 5092706994 Receives reassigned benefits from 29 practitioners
Practice locations: Lake City, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296432000000",
    "number": "1194945097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4367 NW AMERICAN LANE",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320554828",
            "telephone_number": "386-758-6094",
            "fax_number": "386-758-6995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4367 NW AMERICAN LN",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320554828",
            "telephone_number": "386-758-6094",
            "fax_number": "386-758-6995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIZWANA THANAWALA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2011-01-31",
        "status": "A",
        "authorized_official_last_name": "THANAWALA",
        "authorized_official_first_name": "RIZWANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-758-6094",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP ID",
            "identifier": "74502",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266910200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.