NPIMap

Organization Active NPI

West Florida Medical Associates, PA

  • Rural Health Clinic/Center
  • Crystal River, FL
National Provider Identifier
1457499576
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
ME0029731 Issued in FL
Legal business name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Practice address
7647 W Gulf to Lake Hwy
Crystal River, FL 34429-7962
Phone
(352) 795-1718
Fax
(352) 795-7898
NPI assigned
Feb 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Dr. Charles S Li, MD
Title
Physician
Phone
(352) 795-1718

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X ME0029731 FL Primary

Addresses

Primary practice location

7647 W Gulf to Lake Hwy
Crystal River, FL 34429-7962

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
660075100MedicaidFL

Other names 1

  • Charles S. Li, MD Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101123000926 FL Part A Provider - Rural Health Clinic 9032023221 Practice locations: Crystal River, FL

Rural health clinic certification: CCN 103954

Legal name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
CHARLES S. LI MD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 10, 1997
Last certification
Sep 29, 2020
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jun 5, 1997 in FL
Enrollment address
7647 W. Gulf to Lake Hwy
Crystal River, FL 34429-6712

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
Lri Medical28 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

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
Cheng S Li Individual W-2 Managing EmployeeAdministrator Feb 10, 1997
Uday Hiremath Individual 5% Or Greater Direct Ownership Interest Oct 13, 2022 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": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1457499576",
    "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": "7647 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344297962",
            "telephone_number": "352-795-1718",
            "fax_number": "352-795-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FLORIDA MEDICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "LI",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "352-795-1718",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "ME0029731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660075100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles S. Li, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crystal River, FL

Sources for this page

Verify at the official NPI Registry.