NPIMap

Individual provider Active NPI

Iqbal Ahmed Faruqui, MD

  • Internal Medicine Physician
  • Blountstown, FL
National Provider Identifier
1841267010
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME62707 Issued in FL
Practice address
20454 NE Finley Ave
Blountstown, FL 32424-6012
Phone
(850) 674-2221
Fax
(850) 674-2121
NPI assigned
Mar 7, 2006
Last updated
Feb 16, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME62707 FL Primary

Addresses

Primary practice location

20454 NE Finley Ave
Blountstown, FL 32424-6012

Mailing address

20454 NE Finley Ave
PO Box 532
Blountstown, FL 32424-6012
Phone (850) 674-2221

Other identifiers 1

IdentifierTypeStateIssuer
371483700MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031208000449 FL Practitioner - Internal MedicinePractitioner - Family Practice 4880504109 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Center LLCGroup PAC ID 2062322373, 3 clinicians

Practice addresses (Care Compare)

20454 NE Finley Ave
Blountstown, FL 32424-6012
Phone (850) 674-2221

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME62707FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Department of Children and Families CurrentSince Dec 25, 1998 Accepting new patients
Florida Department of Children and Families CurrentSince Dec 25, 1998 Accepting new patients
Florida Department of Children and Families CurrentSince Dec 25, 1998 Accepting new patients
Emcare Physician Providers, Inc. Past Accepting new patients
Dassee Community Health Systems Past Accepting new patients

Locations

100 N Main St
Chattahoochee, FL 32324
Phone (850) 663-7001

100 N Main St
Bldg 1028
Chattahoochee, FL 32324
Phone (904) 330-2215

7487 S State Road 121
Macclenny, FL 32063
Phone (904) 259-6211

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
River Valley Rehabilitation CenterBlountstown, FL, CCN 105473 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 1996
Jan 1, 1996
The Medical Center of BlountstownBlountstown, FL, CCN 108963 Rural health clinic 5% Or Greater Direct Ownership Interest (55%)
Corporate Director		 Mar 1, 2002
Jun 4, 2003

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1841267010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20454 NE FINLEY AVE",
            "address_2": "PO BOX 532",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324246012",
            "telephone_number": "850-674-2221",
            "fax_number": "850-674-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20454 NE FINLEY AVE",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324246012",
            "telephone_number": "850-674-2221",
            "fax_number": "850-674-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARUQUI",
        "first_name": "IQBAL",
        "middle_name": "AHMED",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-07",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME62707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371483700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blountstown, FL

Sources for this page

Verify at the official NPI Registry.