West Florida Medical Associates, PA
Organization Active NPI Rural Health Clinic/Center · Beverly Hills, FL
NPI 1356489314 · NPPES record last updated Dec 17, 2008
Key facts
- NPI
- 1356489314
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- ME0055461 (FL)
- Legal business name
- WEST FLORIDA MEDICAL ASSOCIATES, PA
- Practice address
- 3400 N Lecanto Hwy
Beverly Hills, FL 34465-3548 - Phone
- (352) 746-2227
- Fax
- (352) 746-3587
- NPI assigned
- Feb 2, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Mariananda P Kumar, MD
- Title
- Physician
- Phone
- (352) 746-2227
Owners & managing parties with NPI records 2
-
Bhadresh K Patel, M.D.
-
Alex Tan Villacastin, M.D.
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 16
Corporate family (same tax ID) 1
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 103942
- Legal name
- WEST FLORIDA MEDICAL ASSOCIATES, PA
- Doing business as
- NATURE COAST FAMILY MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 30, 1996
- Last certification
- Sep 19, 2023
- Ownership / control type
- 1A
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jun 5, 1997 in FL
- Enrollment address
- 3400 N Lecanto Hwy
Beverly Hills, FL 34465-3548
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Uday Hiremath |
5% Or Greater Direct Ownership Interest | Oct 13, 2022 | 100% |
| Bhadresh Patel |
W-2 Managing Employee | Jan 1, 2022 | |
| Alex Tan Villacastin |
W-2 Managing Employee | Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040401000131 | FL | Part B Supplier - Clinic/Group Practice | 9032023221 |
Receives reassigned benefits from 70 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Inglis, FL; Inverness, FL; Citrus Springs, FL; Lecanto, FL; Wildwood, FL; Hernando, FL; Floral City, FL; Dunnellon, FL… |
| O20081217000364 | FL | Part a Provider - Rural Health Clinic | 9032023221 | Practice locations: Beverly Hills, FL |
National Provider Directory
- Tax ID family
- Nature Coast Family Medical Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | ME0055461 | FL | Yes |
Addresses
Primary practice location
3400 N Lecanto Hwy
Beverly Hills, FL 34465-3548
Mailing address
PO Box 640573
Beverly Hills, FL 34464-0573
Phone (352) 746-1558
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 660071900 | Medicaid | FL |
Other names
- Nature Coast Family Medical Clinic
Other providers in Beverly Hills, FL
- Lisa Ware
- Alexandra Weinmann
- West Florida Medical Associates P a
- West Florida Medical Associates P a
- West Florida Medical Associates, PA
- West Florida Medical Associates, PA
- William C Chaney DC PA
- Pheriba Theresa Wilson
- Sandrew Wright II
All providers in Beverly Hills, 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 Dec 17, 2008. 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.