Advanced Vascular Institute, LLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

ADVANCED VASCULAR INSTITUTE, LLC

Practice address

2401 State Ave Ste 100
Panama City, FL 32405-3942

Phone

(502) 262-5980

NPI assigned

Feb 8, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Ahmed Aly Farag, MDNPI 1659722361

Title

Cmo

Phone

(850) 628-9177

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ahmed Aly Farag, M.D.

  • Diagnostic Radiology Physician
  • Miami, FL
  • NPI 1659722361

  Vascular & Interventional Radiology

  Medicare reassignment NPD Authorized official
• Ashley Hensley, PA-C

  • Physician Assistant
  • Panama City, FL
  • NPI 1699573576
  NPD
• Marion Virgil Sanders IV, PA-C

  • Physician Assistant
  • Panama City, FL
  • NPI 1093045668
  NPD (past)

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

{
    "created_epoch": "1707350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1700640802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 STATE AVE STE 100",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324053942",
            "telephone_number": "502-262-5980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 STATE AVE STE 100",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324053942",
            "telephone_number": "502-262-5980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED VASCULAR INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-08",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "FARAG",
        "authorized_official_first_name": "AHMED",
        "authorized_official_middle_name": "ALY",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "850-628-9177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vascular & Interventional Radiology Physician in Panama City, FL
• Providers in Panama City, FL by specialty
• Vascular & Interventional Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.