Individual provider Active NPI

Omar Kawwaff, M.D.

  • Infectious Disease Physician
  • Jacksonville, FL
National Provider Identifier
1740244805
Registry record updated Aug 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
ME 50380 Issued in FL
Practice address
4123 University Blvd S
Suite a
Jacksonville, FL 32216-4371
Phone
(904) 737-2801
Fax
(904) 737-2441
NPI assigned
Apr 14, 2006
Last updated
Aug 23, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X ME 50380 FL Primary

Addresses

Primary practice location

4123 University Blvd S
Suite a
Jacksonville, FL 32216-4371

Mailing address

4123 University Blvd S
Suite a
Jacksonville, FL 32216-4371
Phone (904) 737-2801

Other identifiers 2

IdentifierTypeStateIssuer
055732300MedicaidFL
110051678OtherFLRAILRAOD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050914000657 FL Practitioner - Infectious Disease 1850324435 Receives reassigned benefits from 2 practitioners
Practice locations: Jacksonville, FL

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3625 University Blvd S
Jacksonville, FL 32216-4207
Phone (904) 537-3020

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 50380FLMDInfectious Disease Physician

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.

Hospital & facility affiliations 5

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": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314057600000",
    "number": "1740244805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4123 UNIVERSITY BLVD S",
            "address_2": "SUITE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164371",
            "telephone_number": "904-737-2801",
            "fax_number": "904-737-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4123 UNIVERSITY BLVD S",
            "address_2": "SUITE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164371",
            "telephone_number": "904-737-2801",
            "fax_number": "904-737-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAWWAFF",
        "first_name": "OMAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2011-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "FL",
            "license": "ME 50380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "055732300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILRAOD MEDICARE",
            "identifier": "110051678",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.