NPIMap

Organization Active NPI

Weirsdale Family Health Center Inc

  • Rural Health Clinic/Center
  • Weirsdale, FL
National Provider Identifier
1669548392
Registry record updated Jul 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WEIRSDALE FAMILY HEALTH CENTER INC
Practice address
16400 S Highway 25
Weirsdale, FL 32195-0008
Phone
(352) 821-9797
Fax
(352) 821-0553
NPI assigned
Nov 27, 2006
Last updated
Jul 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2023

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

Authorized official

Name
Dharti Bisht
Title
Administrator
Phone
(352) 821-9797

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X FL Primary
Medical Physician Assistant 363AM0700X NU
Nurse Practitioner 363L00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

16400 S Highway 25
Weirsdale, FL 32195-0008

Mailing address

16400 S Highway 25
Weirsdale, FL 32195-2442
Phone (352) 821-9797

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040220001060 FL Part A Provider - Rural Health Clinic 7214822881 Practice locations: Weirsdale, FL
O20040812001252 FL Part B Supplier - Clinic/Group Practice 7214822881 Receives reassigned benefits from 29 practitioners
Practice locations: Weirsdale, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669548392. Details of each certification follow.

Rural health clinic certification: CCN 108934

Legal name
WEIRSDALE FAMILY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 27, 2001
Last certification
Sep 9, 2019
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Sep 14, 2000 in FL
Enrollment address
16400 S Highway 25
Weirsdale, FL 32195-2442

National Provider Directory

National Provider Directory

Locations

16400 S Highway 25
Weirsdale, FL 32195
Phone (352) 821-9797

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Waheeduz Zaman Individual 5% Or Greater Direct Ownership Interest Aug 1, 2012 16.6%
Dharti Bisht Individual W-2 Managing Employee Aug 1, 2012
Shahbaz Ali Cheema Individual 5% Or Greater Direct Ownership Interest Aug 1, 2012 16.6%
Ajay H Bisht Individual 5% Or Greater Direct Ownership Interest Aug 1, 2012 16.6%
Khai Sheng Chang Individual 5% Or Greater Direct Ownership Interest Aug 1, 2012 16.6%
Ma Thuzar Aung Individual 5% Or Greater Direct Ownership Interest Aug 1, 2012 16.6%
Birendra Bhattarai Individual 5% Or Greater Direct Ownership Interest Aug 1, 2012 16.6%

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688342400000",
    "number": "1669548392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16400 S HIGHWAY 25",
            "city": "WEIRSDALE",
            "state": "FL",
            "postal_code": "321952442",
            "telephone_number": "352-821-9797",
            "fax_number": "352-821-0553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16400 S HIGHWAY 25",
            "city": "WEIRSDALE",
            "state": "FL",
            "postal_code": "321950008",
            "telephone_number": "352-821-9797",
            "fax_number": "352-821-0553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEIRSDALE FAMILY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A",
        "authorized_official_last_name": "BISHT",
        "authorized_official_first_name": "DHARTI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "352-821-9797"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weirsdale, FL

Sources for this page

Verify at the official NPI Registry.