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  5. SANJAY A.PATEL MD PA

SANJAY A.PATEL MD PA

Company Details

Entity Name: SANJAY A.PATEL MD PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 20 Apr 2000 (25 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 08 Oct 2013 (11 years ago)
Document Number: P00000039462
FEI/EIN Number 593636232
Address: 419 sw 15th street, ocala, FL, 34471, US
Mail Address: 419 sw 15th street, ocala, FL, 34471, US
ZIP code: 34471
County: Marion
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1407170632 2010-03-17 2024-05-21 419 SW 15TH ST, OCALA, FL, 344710609, US 419 SW 15TH ST, OCALA, FL, 344710609, US

Contacts
Phone +1 352-732-6400
Fax 3526715283

Authorized person
Name MRS. KASHMIRA SANJAY PATEL
Role OFFICE MANAGER
Phone 3527326400

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number ME69007
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 272508800
State FL
Issuer MEDICARE PROVIDER NUMBER
Number 27591
State FL
Issuer UPIN
Number G11717
State FL
Issuer ME LICENSE
Number 69007
State FL
Issuer CLIA ID
Number 10D0974350
Issuer NPI ENTITY TYPE ONE ID
Number 1003866823
State FL
Issuer RAILROAD MEDICARE ID
Number 110204280
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SANJAY A PATEL MD PA 401(K) PROFIT SHARING PLAN & TRUST 2023 593636232 2024-04-09 SANJAY A PATEL MD PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3527326400
Plan sponsor’s address 419 SW 15TH ST, OCALA, FL, 344710486

Signature of
Role Plan administrator
Date 2024-04-09
Name of individual signing SANJAY PATEL
Valid signature Filed with authorized/valid electronic signature
SANJAY A PATEL MD PA 401(K) PROFIT SHARING PLAN & TRUST 2022 593636232 2023-04-17 SANJAY A PATEL MD PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3527326400
Plan sponsor’s address 419 SW 15TH STREET, OCALA, FL, 344710609

Signature of
Role Plan administrator
Date 2023-04-17
Name of individual signing SANJAY A PATEL
Valid signature Filed with authorized/valid electronic signature
SANJAY A PATEL MD PA 401(K) PROFIT SHARING PLAN & TRUST 2021 593636232 2022-04-05 SANJAY A PATEL MD PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3527326400
Plan sponsor’s address 310 SE 29TH PL STE 100, OCALA, FL, 344710486

Signature of
Role Plan administrator
Date 2022-04-05
Name of individual signing SANJAY A PATEL
Valid signature Filed with authorized/valid electronic signature
SANJAY A PATEL MD PA 401(K) PROFIT SHARING PLAN & TRUST 2020 593636232 2021-04-12 SANJAY A PATEL MD PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3527326400
Plan sponsor’s address 310 SE 29TH PL STE 100, OCALA, FL, 344710486

Signature of
Role Plan administrator
Date 2021-04-12
Name of individual signing KASHMIRA PATEL
Valid signature Filed with authorized/valid electronic signature
SANJAY A PATEL MD PA 401(K) PROFIT SHARING PLAN & TRUST 2019 593636232 2020-04-10 SANJAY A PATEL MD PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3527326400
Plan sponsor’s address 310 SE 29TH PL STE 100, OCALA, FL, 344710486

Signature of
Role Plan administrator
Date 2020-04-10
Name of individual signing KASHMIRA PATEL
Valid signature Filed with authorized/valid electronic signature
SANJAY A PATEL MD PA 401 K PROFIT SHARING PLAN TRUST 2018 593636232 2019-05-14 SANJAY A PATEL MD PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3527326400
Plan sponsor’s address 310 SE 29TH PL STE 100, OCALA, FL, 344710486

Signature of
Role Plan administrator
Date 2019-05-14
Name of individual signing KASHMIRA PATEL
Valid signature Filed with authorized/valid electronic signature
SANJAY A PATEL MD PA 401 K PROFIT SHARING PLAN TRUST 2017 593636232 2018-04-09 SANJAY A PATEL MD PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3527326400
Plan sponsor’s address 310 SE 29TH PL STE 100, OCALA, FL, 344710486

Signature of
Role Plan administrator
Date 2018-04-09
Name of individual signing KASHMIRA PATEL
Valid signature Filed with authorized/valid electronic signature
SANJAY A PATEL MD PA 401 K PROFIT SHARING PLAN TRUST 2016 593636232 2017-05-16 SANJAY A PATEL MD PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3527326400
Plan sponsor’s address 310 SE 29TH PL STE 100, OCALA, FL, 344710486

Signature of
Role Plan administrator
Date 2017-05-16
Name of individual signing KASHMRIA PATEL
Valid signature Filed with authorized/valid electronic signature
SANJAY A PATEL MD PA 401 K PROFIT SHARING PLAN TRUST 2016 593636232 2017-05-16 SANJAY A PATEL MD PA 5
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3527326400
Plan sponsor’s address 310 SE 29TH PL STE 100, OCALA, FL, 344710486

Signature of
Role Plan administrator
Date 2017-05-16
Name of individual signing KASHMRIA PATEL
Valid signature Filed with authorized/valid electronic signature
SANJAY A PATEL MD PA 401 K PROFIT SHARING PLAN TRUST 2015 593636232 2016-06-08 SANJAY A PATEL MD PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3527326400
Plan sponsor’s address 310 SE 29TH PL STE 100, OCALA, FL, 344710486

Signature of
Role Plan administrator
Date 2016-06-08
Name of individual signing KASHMIRA PATEL
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PATEL SANJAY A Agent 419 sw 15th street, ocala, FL, 34471

President

Name Role Address
Patel Sanjay A President 419 sw 15th street, ocala, FL, 34471

Secretary

Name Role Address
Patel Sanjay A Secretary 419 sw 15th street, ocala, FL, 34471

Treasurer

Name Role Address
Patel Sanjay A Treasurer 419 sw 15th street, ocala, FL, 34471

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2023-02-28 419 sw 15th street, ocala, FL 34471 No data
CHANGE OF PRINCIPAL ADDRESS 2023-02-28 419 sw 15th street, ocala, FL 34471 No data
CHANGE OF MAILING ADDRESS 2023-02-28 419 sw 15th street, ocala, FL 34471 No data
REINSTATEMENT 2013-10-08 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2013-09-27 No data No data
REINSTATEMENT 2010-02-19 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2009-09-25 No data No data
REGISTERED AGENT NAME CHANGED 2006-04-28 PATEL, SANJAY A No data

Documents

Name Date
ANNUAL REPORT 2025-01-24
ANNUAL REPORT 2024-03-05
ANNUAL REPORT 2023-02-28
ANNUAL REPORT 2022-01-16
ANNUAL REPORT 2021-01-08
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-01-03
ANNUAL REPORT 2018-01-09
ANNUAL REPORT 2017-01-06
ANNUAL REPORT 2016-01-24

Related by officers

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Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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