NPIMap

Organization Active NPI

Harbor Medical Group LLC

  • Internal Medicine Physician
  • Port Charlotte, FL
National Provider Identifier
1689184335
Registry record updated May 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
HARBOR MEDICAL GROUP LLC
Practice address
21202 Olean Blvd Ste C1
Port Charlotte, FL 33952-6725
Phone
(941) 889-7440
Fax
(941) 391-6089
NPI assigned
Oct 9, 2017
Last updated
May 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2023

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

Authorized official

Name
Ahsan Kamal, MDNPI 1760602049
Title
Owner
Phone
(941) 889-7440

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
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

21202 Olean Blvd Ste C1
Port Charlotte, FL 33952-6725

Mailing address

21202 Olean Blvd Ste C1
Port Charlotte, FL 33952-6725
Phone (941) 889-7440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180409000922 FL Part B Supplier - Clinic/Group Practice 5092078881 Receives reassigned benefits from 26 practitioners
Practice locations: Port Charlotte, FL; Punta Gorda, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1507507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683244800000",
    "number": "1689184335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21202 OLEAN BLVD STE C1",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526725",
            "telephone_number": "941-889-7440",
            "fax_number": "941-391-6089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21202 OLEAN BLVD STE C1",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526725",
            "telephone_number": "941-889-7440",
            "fax_number": "941-391-6089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-09",
        "last_updated": "2023-05-05",
        "certification_date": "2023-05-05",
        "status": "A",
        "authorized_official_last_name": "KAMAL",
        "authorized_official_first_name": "AHSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-889-7440",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.