NPIMap

Individual provider Active NPI

Hani Issa, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Penny Farms, FL
National Provider Identifier
1619144045
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
ME133628 Issued in FL
Practice address
2 Pavillon Place
Penny Farms, FL 32079
Phone
(904) 388-3351
NPI assigned
May 14, 2008
Last updated
Aug 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125050623 IL
Internal Medicine Physician 207R00000X ME133628 FL
Geriatric Medicine (Internal Medicine) Physician 207RG0300X ME133628 FL Primary

Addresses

Primary practice location

2 Pavillon Place
Penny Farms, FL 32079

Mailing address

1907 Atlantic Blvd
Jacksonville, FL 32207-3405
Phone (043) 883-3519

Other identifiers 1

IdentifierTypeStateIssuer
ME133628OtherFLMEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL haniissa1978@gmail.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170928001398 FL Practitioner - Geriatric MedicinePractitioner - Internal Medicine 2668621236 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2 Pavillion Place
Penny Farms, FL 32079
Phone (904) 388-3351

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME133628FLMDInternal Medicine Physician
125050623ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Issa.Med P.a. Geriatric Medicine CurrentSince Aug 25, 2021 Accepting new patients
St Vincents Ambulatory Care Inc Internal Medicine CurrentSince Nov 15, 2019 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Nov 15, 2019 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Cristina Luciano M D P a Past Accepting new patients

Locations

1907 Atlantic Blvd
Jacksonville, FL 32207
Phone 9043883351326

1658 St Vincents Way
Ste 100
Middleburg, FL 32068
Phone (904) 354-8200

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Pavilion for HealthcarePenney Farms, FL, CCN 106096 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2023
Jan 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1619144045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 ATLANTIC BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322073405",
            "telephone_number": "043-883-3519",
            "fax_number": "904-389-3507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PAVILLON PLACE",
            "city": "PENNY FARMS",
            "state": "FL",
            "postal_code": "32079",
            "telephone_number": "904-388-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISSA",
        "first_name": "HANI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-14",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125050623",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME133628",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME133628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME133628",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "haniissa1978@gmail.com",
            "affiliation": "N",
            "endpointDescription": "haniissa1978@gmail.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "1907 Atlantic Blvd",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322073405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Penny Farms, FL

Sources for this page

Verify at the official NPI Registry.