Issa.Med P.a.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

ISSA.MED P.A.

Practice address

2 Pavillion Place
Penney Farms, FL 32079

Phone

(217) 416-6431

NPI assigned

Aug 4, 2021

Last updated

Aug 4, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Hani Issa, M.D.NPI 1619144045

Title

President

Phone

(217) 416-6431

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

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.

• Hani Issa, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Penny Farms, FL
  • NPI 1619144045
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1628035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1376217364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 ATLANTIC BLVD STE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322073405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PAVILLION PLACE",
            "city": "PENNEY FARMS",
            "state": "FL",
            "postal_code": "32079",
            "telephone_number": "217-416-6431"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3497 Caroline Blvd",
            "address_purpose": "LOCATION",
            "city": "Penney Farms",
            "state": "FL",
            "postal_code": "32079",
            "country_code": "US",
            "telephone_number": "217-416-6431",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4410 Lewis Ave",
            "address_purpose": "LOCATION",
            "city": "Penney Farms",
            "state": "FL",
            "postal_code": "32079",
            "country_code": "US",
            "telephone_number": "217-416-6431",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4510 Lewis Ave",
            "address_purpose": "LOCATION",
            "city": "Penney Farms",
            "state": "FL",
            "postal_code": "32079",
            "country_code": "US",
            "telephone_number": "217-416-6431",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3465 Caroline Blvd",
            "address_purpose": "LOCATION",
            "city": "Penney Farms",
            "state": "FL",
            "postal_code": "32079",
            "country_code": "US",
            "telephone_number": "217-416-6431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ISSA.MED P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-04",
        "last_updated": "2021-08-04",
        "certification_date": "2021-07-09",
        "status": "A",
        "authorized_official_last_name": "ISSA",
        "authorized_official_first_name": "HANI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-416-6431",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "E-clinical",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2 Pavillion Place",
            "city": "Penney Farms",
            "state": "FL",
            "country_code": "US",
            "postal_code": "32079",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cristina Luciano M D P a
• Caitlyn Ann Cullaro, COTA/L
• Sibonii Dixon
• Douglas M Tew MD LLC
• Kristina Ketterer, COTA
• Janet Keys, PTA
• Katarina Elaine Norton
• Outpatient Clinic at Penney Retirement Community, Inc.
• Penney Retirement Community

• Geriatric Medicine (Internal Medicine) Physician in Penney Farms, FL
• Providers in Penney Farms, FL by specialty
• Geriatric Medicine (Internal Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.