NPIMap

Organization Active NPI

Premier Gastroenterology PA

  • Gastroenterology Physician
  • Brooksville, FL
National Provider Identifier
1235246240
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
ME69833 Issued in FL
Legal business name
PREMIER GASTROENTEROLOGY PA
Practice address
12102 Cortez Blvd
Brooksville, FL 34613-5514
Phone
(352) 597-4000
Fax
(352) 597-0550
NPI assigned
Aug 24, 2006
Last updated
Jun 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Authorized official

Name
Dr. Muhammed-Rodwan Ali Hiba, MDNPI 1194833392
Title
Owner/Ceo
Phone
(352) 597-4000

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 ME69833 FL Primary

Addresses

Primary practice location

12102 Cortez Blvd
Brooksville, FL 34613-5514

Mailing address

12102 Cortez Blvd
Brooksville, FL 34613-5514
Phone (352) 597-4000

Other identifiers 9

IdentifierTypeStateIssuer
100016261OtherRAILROAD MEDICARE
2987121OtherUHC
360846358OtherFIRST HEALTH
2593473OtherGHI
7130182OtherAETNA
2119601215701OtherBEECH ST
1003105OtherHUMANA
2579162-0MedicaidFL
49489OtherBCBS

Other names 1

  • M Rodwan Hiba Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050615000651 FL Part B Supplier - Clinic/Group Practice 8921042417 Receives reassigned benefits from 5 practitioners
Practice locations: Brooksville, FL

National Provider Directory

National Provider Directory

Locations

12102 Cortez Blvd
Brooksville, FL 34613
Phone (352) 597-0022

14540 Cortez Blvd
Ste 120
Brooksville, FL 34613
Phone (352) 596-1000

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1235246240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12102 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346135514",
            "telephone_number": "352-597-4000",
            "fax_number": "352-597-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12102 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346135514",
            "telephone_number": "352-597-4000",
            "fax_number": "352-597-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER GASTROENTEROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2024-06-10",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "HIBA",
        "authorized_official_first_name": "MUHAMMED-RODWAN",
        "authorized_official_middle_name": "ALI",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "352-597-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME69833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "100016261",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "2987121",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "360846358",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2593473",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7130182",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEECH ST",
            "identifier": "2119601215701",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "1003105",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2579162-0",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "49489",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "M Rodwan Hiba",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 10, 2024; 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.