Active NPI
Bonita Springs Home Health LLC
- Home Health Agency
- Gilroy, CA
National Provider Identifier
1568857589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- BONITA SPRINGS HOME HEALTH LLC
- Doing business as
- Bonita Springs Home Health LLC
- Practice address
- 8545 Monterey St
Suite-a
Gilroy, CA 95020-4273 - Phone
- (408) 337-8117
- Fax
- (408) 337-8220
- NPI assigned
- Apr 6, 2015
- Last updated
- Mar 30, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Syeda Mamoona Omer, M.D
- Title
- Ceo/Administrator
- Phone
- (408) 337-8117
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | CA | Primary |
Addresses
Primary practice location
8545 Monterey St
Suite-a
Gilroy, CA 95020-4273
Mailing address
8545 Monterey St
Suite-a
Gilroy, CA 95020-4273
Phone (408) 337-8117
Other names 1
- BONITA SPRINGS HOME HEALTH LLC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151210000001 | CA | Part A Provider - Home Health Agency | 6002117389 | Practice locations: Gilroy, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1568857589. Details of each certification follow.
Home health agency certification: CCN 053142
- Legal name
- BONITA SPRINGS HOME HEALTH LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Feb 7, 2018
- Last certification
- Dec 3, 2020
- Ownership / control type
- Proprietary
- Organization structure
- LLC
- Incorporated
- Mar 30, 2015 in CA
- Enrollment address
- 8545 Monterey St a
Gilroy, CA 95020-4273
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Bonita Springs Home Health LLC
- Overall star rating
- Ownership
- Proprietary
- Certified
- Feb 7, 2018
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryLocations
8545 Monterey St
Gilroy, CA 95020
Phone (408) 337-8117
8545 Monterey St
Ste A
Gilroy, CA 95020
Phone (408) 337-8117
Ownership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Syeda M Omer | 5% Or Greater Direct Ownership Interest | Mar 30, 2015 | 37.5% |
| W-2 Managing Employee | Mar 30, 2015 | 37.5% | |
| Randa Ismail | 5% Or Greater Direct Ownership Interest | Sep 1, 2015 | 25% |
| Mohammed O Qureshi | 5% Or Greater Direct Ownership Interest | Sep 21, 2015 | 37.5% |
Practitioners & affiliated clinicians
Affiliated clinicians 6
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Medicine Physician
- Hollister, CA
- NPI 1891998159
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428278400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1459296000000",
"number": "1568857589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8545 MONTEREY ST",
"address_2": "SUITE-A",
"city": "GILROY",
"state": "CA",
"postal_code": "950204273",
"telephone_number": "408-337-8117",
"fax_number": "408-337-8220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8545 MONTEREY ST",
"address_2": "SUITE-A",
"city": "GILROY",
"state": "CA",
"postal_code": "950204273",
"telephone_number": "408-337-8117",
"fax_number": "408-337-8220"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BONITA SPRINGS HOME HEALTH LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-04-06",
"last_updated": "2016-03-30",
"status": "A",
"authorized_official_last_name": "OMER",
"authorized_official_first_name": "SYEDA",
"authorized_official_middle_name": "MAMOONA",
"authorized_official_title_or_position": "CEO/ADMINISTRATOR",
"authorized_official_telephone_number": "408-337-8117",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "BONITA SPRINGS HOME HEALTH LLC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Gilroy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.