Osama Shuaib Ismail MD LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

OSAMA SHUAIB ISMAIL MD LLC

Practice address

110 E Byrd Ave
Bonifay, FL 32425-3004

Phone

(850) 547-2305

NPI assigned

Feb 28, 2024

Organization subpart

No

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

Authorized official

Name

Osama Shuaib Ismail

Title

Owner

Phone

(850) 319-3361

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Rural health clinic certification: CCN 683847

Legal name

OSAMA SHUAIB ISMAIL MD LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 7, 2023

Last certification

Nov 7, 2023

Ownership / control type

1A

Organization structure

LLCProprietary

Enrollment address

110 E Byrd Ave
Bonifay, FL 32425-3004

Tax ID family

Osama Shuaib Ismail2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Osama Shuaib Ismail

  • Internal Medicine Physician
  • Bonifay, FL
  • NPI 1356913370
  NPD tax ID

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.

Owners & managing parties with NPI records 1

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

• Osama Shuaib Ismail, MD

  • Internal Medicine Physician
  • Bonifay, FL
  • NPI 1548794795

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership

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

{
    "created_epoch": "1709078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1912764788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E BYRD AVE",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "324253004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E BYRD AVE",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "324253004",
            "telephone_number": "850-547-2305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSAMA SHUAIB ISMAIL MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-28",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "ISMAIL",
        "authorized_official_first_name": "OSAMA",
        "authorized_official_middle_name": "SHUAIB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-319-3361"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsie Nesbit, RBT
• Michelle Newton, APRN
• Northwest Florida Healthcare, Inc. (Bailey Family Practice - Northwest Florida Community Hospital)
• Onyx Health LLC
• Osama Shuaib Ismail
• John Stanley Owens, D.C.
• Pak Rural Health
• Pancare of Florida, Inc
• Panhandle Family Medicine, LLC
• Brian A Parker, D.M.D.

• Rural Health Clinic/Center in Bonifay, FL
• Providers in Bonifay, FL by specialty
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.