NPIMap

Organization Active NPI

Premier Care Homecare, LLC

  • Home Health Agency
  • Leesburg, FL
National Provider Identifier
1619990595
Registry record updated Dec 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PREMIER CARE HOMECARE, LLC
Practice address
1218 W Dixie Ave Ste B
Leesburg, FL 34748-6380
Phone
(352) 365-7850
Fax
(352) 365-7856
NPI assigned
Jul 25, 2006
Last updated
Dec 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2022

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

Authorized official

Name
Mr. Bahaa Refat Gerges, PTNPI 1174745020
Title
Chief Financial Officer
Phone
(352) 365-7850

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

1218 W Dixie Ave Ste B
Leesburg, FL 34748-6380

Mailing address

1218 W Dixie Ave Ste B
Leesburg, FL 34748-6380
Phone (352) 365-7850

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070312000311 FL Part A Provider - Home Health Agency 7719080779 Practice locations: Leesburg, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619990595. Details of each certification follow.

Home health agency certification: CCN 108410

Legal name
PREMIER CARE HOMECARE, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 19, 2007
Last certification
Aug 15, 2018
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
1218 W Dixie Ave
Ste B
Leesburg, FL 34748-6380

Care Compare: Home health agency

Medicare Care Compare
Listed as
Premier Care Homecare LLCCCN 108410 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Apr 19, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology

National Provider Directory

National Provider Directory

Locations

1711 Citrus Blvd
Leesburg, FL 34748

426 N 3rd St
Ste B
Leesburg, FL 34748
Phone (352) 365-7850

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

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
Bahaa R Gerges Individual 5% Or Greater Direct Ownership Interest Sep 7, 2006
Corporate Director Sep 7, 2006
Tanya Shoemaker Individual W-2 Managing Employee Sep 7, 2006

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672099200000",
    "number": "1619990595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 W DIXIE AVE STE B",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347486380",
            "telephone_number": "352-365-7850",
            "fax_number": "352-365-7856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 W DIXIE AVE STE B",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347486380",
            "telephone_number": "352-365-7850",
            "fax_number": "352-365-7856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER CARE HOMECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A",
        "authorized_official_last_name": "GERGES",
        "authorized_official_first_name": "BAHAA",
        "authorized_official_middle_name": "REFAT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "352-365-7850",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.