NPIMap

Organization Active NPI

West Florida Medical Associates, PA

Doing business as Deven Medical Clinic

  • Rural Health Clinic/Center
  • Inglis, FL
National Provider Identifier
1437755345
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
Deven Medical Clinic
Practice address
41 N Inglis Ave Ste B
Inglis, FL 34449-9463
Phone
(352) 447-2122
Fax
(352) 465-7576
NPI assigned
Dec 7, 2020
Last updated
Dec 7, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
WEST FLORIDA MEDICAL ASSOCIATES, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Authorized official

Name
Ulhas T Deven, MD
Title
President
Phone
(352) 464-0762

Specialties & licenses 1

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

Addresses

Primary practice location

41 N Inglis Ave Ste B
Inglis, FL 34449-9463

Mailing address

3920 N Grayhawk Loop
Lecanto, FL 34461-8471
Phone (352) 464-0762

Other names 1

  • Deven Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201216000045 FL Part A Provider - Rural Health Clinic 9032023221 Practice locations: Inglis, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437755345. Details of each certification follow.

Rural health clinic certification: CCN 683839

Legal name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
DEVEN MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 20, 2021
Last certification
Apr 12, 2021
Ownership / control type
1A
Organization structure
CorporationProprietary
Incorporated
Nov 15, 1999 in FL
Enrollment address
41 N Inglis Ave, Ste B
Inglis, FL 34449-9463

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

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

Locations

41 N Inglis Ave
#B
Inglis, FL 34449
Phone (352) 447-2122

Ownership & related parties

All disclosed owners & managing parties 2

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%
Ulhas Tarikere Deven Individual W-2 Managing EmployeeOwner/MD Dec 1, 2020 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": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1437755345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 N GRAYHAWK LOOP",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344618471",
            "telephone_number": "352-464-0762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 N INGLIS AVE STE B",
            "city": "INGLIS",
            "state": "FL",
            "postal_code": "344499463",
            "telephone_number": "352-447-2122",
            "fax_number": "352-465-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FLORIDA MEDICAL ASSOCIATES, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST FLORIDA MEDICAL ASSOCIATES, PA",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "DEVEN",
        "authorized_official_first_name": "ULHAS",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-464-0762",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deven Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Inglis, FL

Sources for this page

Verify at the official NPI Registry.