NPIMap

Organization Active NPI

West Florida Medical Associates, PA

Doing business as Suncoast Primary Care Specialists

  • Rural Health Clinic/Center
  • Inverness, FL
National Provider Identifier
1255479218
Registry record updated Jun 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
ME0071085 Issued in FL
Legal business name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
Suncoast Primary Care Specialists
Practice address
3733 E Gulf to Lake Hwy
Inverness, FL 34453-3206
Phone
(352) 465-8001
Fax
(352) 465-8800
NPI assigned
Feb 2, 2007
Last updated
Jun 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2009

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

Authorized official

Name
Dr. Alex Villacastin, MD
Title
Physician
Phone
(352) 341-5520

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X ME0071085 FL Primary

Addresses

Primary practice location

3733 E Gulf to Lake Hwy
Inverness, FL 34453-3206

Mailing address

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

Other names 1

  • Suncoast Primary Care Specialists Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031112000730 FL Part A Provider - Rural Health Clinic 9032023221 Practice locations: Inverness, FL
O20140307001484 FL Part A Provider - Rural Health Clinic 9032023221 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Homosassa, FL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1255479218. Details of each certification follow.

Rural health clinic certification: CCN 108954

Legal name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
SUNCOAST PRIMARY CARE SPECIALISTS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 3, 2003
Last certification
Sep 12, 2023
Ownership / control type
1B
Most recent change of ownership
Apr 4, 2003 (1 total)
Organization structure
CorporationProprietary
Incorporated
Jun 5, 1997 in FL
Enrollment address
3733E Gulf to Lake Hwy
Inverness, FL 34453-3206

Rural health clinic certification: CCN 683814

Legal name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
COMPREHENSIVE PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 3, 2014
Last certification
Sep 15, 2020
Ownership / control type
1B
Organization structure
CorporationProprietary
Enrollment address
4363 S Suncoast Blvd
Homosassa, FL 34446-1182

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 1

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

National Provider Directory

National Provider Directory

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
Uday Hiremath Individual 5% Or Greater Direct Ownership Interest Oct 13, 2022 100%
Alex Tan Villacastin Individual W-2 Managing Employee Apr 3, 2003
Hasibul Hassan Khan Individual 5% Or Greater Direct Ownership InterestDirector Mar 2, 2013 100%
W-2 Managing Employee Mar 2, 2013 100%

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": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245110400000",
    "number": "1255479218",
    "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": "3733 E GULF TO LAKE HWY",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344533206",
            "telephone_number": "352-465-8001",
            "fax_number": "352-465-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FLORIDA MEDICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2009-06-16",
        "status": "A",
        "authorized_official_last_name": "VILLACASTIN",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "352-341-5520",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "ME0071085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suncoast Primary Care Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Inverness, FL

Sources for this page

Verify at the official NPI Registry.