West Florida Medical Associates, PA
Organization Active NPI Rural Health Clinic/Center · Inverness, FL
NPI 1255479218 · NPPES record last updated Jun 16, 2009
Key facts
- NPI
- 1255479218
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- ME0071085 (FL)
- Legal business name
- WEST FLORIDA MEDICAL ASSOCIATES, PA
- 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
- Organization subpart
- No
Authorized official
- Name
- Dr. Alex Villacastin, MD
- Title
- Physician
- Phone
- (352) 341-5520
Owners & managing parties with NPI records 2
-
Alex Tan Villacastin, M.D.
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 16
Member organizations 2
Practitioners 24
-
Venkatreddy Alugubelli, M.D.
-
Kamalakar Amaravadi, M.D
-
Rajendra P Bellam, M.D
-
Alec R Breckenridge, PA-C
-
Alistair C Co, MD
-
Yelandra Daniels, M.D.
-
Ulhas T Deven, M.D.
-
William Steve Gruss, M.D.
-
Rama Rao Kompella, M.D.
-
Bhadresh K Patel, M.D.
-
Shiriskumar G Patel, M.D.
-
Evelyn Rentas, MD
-
Carmen Ana Sierra, M.D.
-
Beena M Stanley, M.D.
-
Alex Tan Villacastin, M.D.
-
Nilesh G Patel, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL
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
- Corporation · Proprietary
- 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
- Corporation · Proprietary
- Enrollment address
- 4363 S Suncoast Blvd
Homosassa, FL 34446-1182
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Uday Hiremath |
5% Or Greater Direct Ownership Interest | Oct 13, 2022 | 100% |
| Alex Tan Villacastin |
W-2 Managing Employee | Apr 3, 2003 | |
| Hasibul Hassan Khan |
5% Or Greater Direct Ownership Interest |
Mar 2, 2013 | 100% |
| W-2 Managing Employee | Mar 2, 2013 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
3733 E Gulf To Lake Hwy
Inverness, FL 34453
Phone (352) 341-5520
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | ME0071085 | FL | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32745 | Other | FL | BCBS OF FLORIDA |
| 660075101 | Medicaid | FL |
Other names
- Suncoast Primary Care Specialists
Other providers in Inverness, FL
- West Coast Dental Partners
- West Coast Eye Institute PA
- West Coast Eye Institute PA
- West Florida Medical Associates P a
- West Florida Medical Associates, P.a.
- West Florida Medical Associates, PA
- West Florida Medical Associates, PA
- West Florida Medical Associates, PA
- West Florida Pediatrics
- West Florida Professional Billing, LLC
All providers in Inverness, FL · Rural Health Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.