NPIMap

Organization Active NPI

West Florida Medical Associates, PA

Doing business as Comprehensive Primary Care

  • Family Medicine Physician
  • Inverness, FL
National Provider Identifier
1770724130
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME100419 Issued in FL
Legal business name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
Comprehensive Primary Care
Practice address
213 S Pine Ave
Inverness, FL 34452-4830
Phone
(352) 560-3000
Fax
(352) 419-6513
NPI assigned
Mar 16, 2009
Last updated
Sep 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

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

Authorized official

Name
Dr. Hasibul H Khan, M.D.NPI 1831251446
Title
Physican
Phone
(352) 560-3000

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9102858 FL
Family Medicine Physician 207Q00000X ME100419 FL Primary
Internal Medicine Physician 207R00000X ME69230 FL

Addresses

Primary practice location

213 S Pine Ave
Inverness, FL 34452-4830

Mailing address

3404 N Lecanto Hwy Ste C
Beverly Hills, FL 34465-3569
Phone (352) 746-1558

Other identifiers 2

IdentifierTypeStateIssuer
001124800MedicaidFL
00281900MedicaidFL

Other names 1

  • Comprehensive Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091017000048 FL Part A Provider - Rural Health Clinic 9032023221 2 other NPIs on this enrollment
Practice locations: Inverness, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770724130. Details of each certification follow.

Rural health clinic certification: CCN 103834

Legal name
WEST FLORIDA MEDICAL ASSOCIATES, PA
Doing business as
COMPREHENSIVE PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 17, 2010
Last certification
May 19, 2022
Ownership / control type
1A
Organization structure
CorporationProprietary
Incorporated
Jun 5, 1997 in FL
Enrollment address
213 S Pine Ave
Inverness, FL 34452-4830

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1097780West Florida Medical Associates213 S Pine Ave, Inverness, FL 34452Certificate of waiverApr 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Lri Medical28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Locations

3404 N Lecanto Hwy
Ste C
Beverly Hills, FL 34465
Phone (352) 746-1558

11707 N Williams St
Ste 2
Dunnellon, FL 34432
Phone (352) 465-1199

20021 SW 111th Pl
Dunnellon, FL 34432
Phone (352) 465-1199

8546 W Homosassa Trl
Ste 3
Homosassa, FL 34448
Phone (352) 621-3100

4363 S Suncoast Blvd
Homosassa Springs, FL 34446
Phone (352) 503-2011

3733 E Gulf To Lake Hwy
Inverness, FL 34453
Phone (352) 341-5520

511 W Highland Blvd
Inverness, FL 34452
Phone (352) 726-4499

2671 W Norvell Bryant Hwy
Unit 1
Lecanto, FL 34461
Phone (352) 513-5906

2671 W Norvell Bryant Hwy
Unit 2
Lecanto, FL 34461
Phone (352) 249-7360

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Hasibul Hassan Khan Individual 5% Or Greater Direct Ownership Interest Jan 1, 2012 100%
W-2 Managing Employee Apr 2, 2008

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 70

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 70

NPI Registry JSON

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

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1770724130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3404 N LECANTO HWY STE C",
            "city": "BEVERLY HILLS",
            "state": "FL",
            "postal_code": "344653569",
            "telephone_number": "352-746-1558",
            "fax_number": "352-746-3838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 S PINE AVE",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344524830",
            "telephone_number": "352-560-3000",
            "fax_number": "352-419-6513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FLORIDA MEDICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-16",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "HASIBUL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PHYSICAN",
        "authorized_official_telephone_number": "352-560-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102858",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME100419",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME69230",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001124800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00281900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comprehensive Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Inverness, FL

Sources for this page

Verify at the official NPI Registry.