NPIMap

Organization Active NPI

West Florida Medical Associates, P. a

Doing business as Comprehensive Primary Care

  • Rural Health Clinic/Center
  • Homosassa Springs, FL
National Provider Identifier
1336454339
Registry record updated Apr 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
ME69230 Issued in FL
Legal business name
WEST FLORIDA MEDICAL ASSOCIATES, P. A
Doing business as
Comprehensive Primary Care
Practice address
4363 South Suncoast Blvd
Homosassa Springs, FL 34446
Phone
(352) 503-2011
Fax
(352) 503-6892
NPI assigned
Aug 13, 2010
Last updated
Apr 10, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
WEST FLORIDA MEDICAL ASSOCIATES, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 10, 2013

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

Authorized official

Name
Hasibul H. Khan, M.D.
Title
Physician/Director
Phone
(352) 503-2011

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X ME100419 FL
Rural Health Clinic/Center 261QR1300X ME69230 FL Primary

Addresses

Primary practice location

4363 South Suncoast Blvd
Homosassa Springs, FL 34446

Mailing address

3404 N. Lecanto Hwy
Suite C
Beverly Hills, FL 34465
Phone (352) 746-1558

Other identifiers 2

IdentifierTypeStateIssuer
252639500MedicaidFL
378926800MedicaidFL

Other names 1

  • Comprehensive Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140307001484 FL Part A Provider - Rural Health Clinic 9032023221 1 other NPI on this enrollment
Practice locations: Homosassa, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336454339. Details of each certification follow.

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
Tax ID family
West FL Medical Assoc L28 organizations share this tax ID, including this one
Part of
West FL Medical Assoc L

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 1

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

NameRoleSinceShare
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 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": "1281657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365552000000",
    "number": "1336454339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3404 N. LECANTO HWY",
            "address_2": "SUITE C",
            "city": "BEVERLY HILLS",
            "state": "FL",
            "postal_code": "34465",
            "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": "4363 SOUTH SUNCOAST BLVD",
            "city": "HOMOSASSA SPRINGS",
            "state": "FL",
            "postal_code": "34446",
            "telephone_number": "352-503-2011",
            "fax_number": "352-503-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FLORIDA MEDICAL ASSOCIATES, P. A",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST FLORIDA MEDICAL ASSOCIATES, P.A.",
        "enumeration_date": "2010-08-13",
        "last_updated": "2013-04-10",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "HASIBUL",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PHYSICIAN/DIRECTOR",
        "authorized_official_telephone_number": "352-503-2011",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "ME100419",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "ME69230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252639500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378926800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comprehensive Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Homosassa Springs, FL

Sources for this page

Verify at the official NPI Registry.