NPIMap

Organization Active NPI

West Florida Medical Associates, PA

Doing business as West Florida Pediatrics

  • Rural Health Clinic/Center
  • Inverness, FL
National Provider Identifier
1407994510
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
ME0042494 Issued in FL
Legal business name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
West Florida Pediatrics
Practice address
405 N. Central Ave.
Inverness, FL 34453-3838
Phone
(352) 341-2400
Fax
(352) 341-2401
NPI assigned
Feb 1, 2007
Last updated
Oct 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Uday Hiremath, MDNPI 1497747216
Title
Physician
Phone
(352) 746-3888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X ME0042494 FL Primary

Addresses

Primary practice location

405 N. Central Ave.
Inverness, FL 34453-3838

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
660071900MedicaidFL

Other names 1

  • West Florida Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090409000610 FL Part A Provider - Rural Health Clinic 9032023221 Practice locations: Inverness, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407994510. Details of each certification follow.

Rural health clinic certification: CCN 108905

Legal name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
WEST FLORIDA PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 27, 1998
Last certification
Feb 6, 2024
Ownership / control type
Non-profit – corporation
Organization structure
CorporationProprietary
Incorporated
Jun 5, 1997 in FL
Enrollment address
405 N Central Ave
Inverness, FL 34453-3838

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2020975Childrens Clinic West Florida Pediatrics405 N Central Avenue, Inverness, FL 34453Certificate of waiverMar 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
West FL Medical Assoc L28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Locations

405 N Central Ave
Inverness, FL 34453
Phone (352) 341-2400

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
Uday Hiremath Individual 5% Or Greater Direct Ownership Interest Oct 13, 2022 100%
W-2 Managing Employee Oct 13, 2022

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1407994510",
    "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": "405 N. CENTRAL AVE.",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344533838",
            "telephone_number": "352-341-2400",
            "fax_number": "352-341-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FLORIDA MEDICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "HIREMATH",
        "authorized_official_first_name": "UDAY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "352-746-3888",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "ME0042494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660071900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Florida Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Inverness, FL

Sources for this page

Verify at the official NPI Registry.