Medical Center LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MEDICAL CENTER LLC

Practice address

20454 NE Finley Ave
Blountstown, FL 32424-6012

Phone

(850) 674-2221

Fax

(850) 674-2121

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Iqbal A Fauqui, MD

Title

Owner President

Phone

(850) 674-2221

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Medical Center of Blountstown Doing business as

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 108963

Legal name

MEDICAL CENTER LLC

Doing business as

THE MEDICAL CENTER OF BLOUNTSTOWN

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 4, 2003

Last certification

Jun 1, 2022

Ownership / control type

1B

Organization structure

LLCProprietary

Incorporated

May 20, 2002 in FL

Enrollment address

20454 Nefinley Ave
Blountstown, FL 32424-6012

Locations

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.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Iqbal Ahmed Faruqui, MD

  • Internal Medicine Physician
  • Blountstown, FL
  • NPI 1841267010

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Angela Nacole Blount, APRN

  • Family Nurse Practitioner
  • Marianna, FL
  • NPI 1952154148
  Care Compare group
• Misbah I Farooqi, M.D.

  • Internal Medicine Physician
  • Blountstown, FL
  • NPI 1710986286
  Care Compare group
• Iqbal Ahmed Faruqui, MD

  • Internal Medicine Physician
  • Blountstown, FL
  • NPI 1841267010
  Care Compare group

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1508929050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20454 NE FINLEY AVE",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324246012",
            "telephone_number": "850-674-2221",
            "fax_number": "850-674-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20454 NE FINLEY AVE",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324246012",
            "telephone_number": "850-674-2221",
            "fax_number": "850-674-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "FAUQUI",
        "authorized_official_first_name": "IQBAL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "850-674-2221",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660205300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Medical Center of Blountstown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pamela Diane Mash, COUNSELOR
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• William T. McClellan, D.C.
• Karah McDougald
• Michael B. McKenzie, ARNP
• Myron D. Schrock, D.M.D., P.a.
• New Millennium Training LLC
• Hayley Sumner Nichols, APRN
• Nieves Home Care Services
• Nieves Home Care Transportation LLC

• Internal Medicine Physician in Blountstown, FL
• Providers in Blountstown, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.