Leesburg Pediatrics PA

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

LEESBURG PEDIATRICS PA

Practice address

8113 Centralia CT
Leesburg, FL 34788-7508

Phone

(352) 435-7938

Fax

(352) 805-4145

NPI assigned

Jul 24, 2013

Organization subpart

No

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

Authorized official

Name

Mohammad Afzal, MDNPI 1669411161

Title

Owner

Phone

(352) 394-3929

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Rural health clinic certification: CCN 683841

Legal name

LEESBURG PEDIATRICS PA

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 16, 2021

Last certification

Nov 16, 2021

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

May 6, 2013 in FL

Enrollment address

8113 Centralia CT
Leesburg, FL 34788-7508

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

CLIA laboratory certificates

Locations

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.

• Mohammad Afzal, MD MBA

  • Pediatrics Physician
  • Clermont, FL
  • NPI 1669411161

  5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohammad Afzal, MD MBA

  • Pediatrics Physician
  • Clermont, FL
  • NPI 1669411161
  NPD (past) Authorized official
• Tiffany Marie Guice, APRN

  • Nurse Practitioner
  • The Villages, FL
  • NPI 1548773336
  NPD (past)
• Melissa Rodden, ARNP

  • Family Nurse Practitioner
  • Leesburg, FL
  • NPI 1013430958
  NPD (past)

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1003258666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8113 CENTRALIA CT",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347887508",
            "telephone_number": "352-435-7938",
            "fax_number": "352-805-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8113 CENTRALIA CT",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347887508",
            "telephone_number": "352-435-7938",
            "fax_number": "352-805-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEESBURG PEDIATRICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-24",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "AFZAL",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-394-3929",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112711800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leesburg Chiropractic Center, Inc
• Leesburg Family Medicine
• Leesburg Health & Rehab LLC
• Leesburg Health and Rehab
• Leesburg Pain & Rehab, Inc
• Leesburg Primary Care Center, LLC
• Leesburg Psychology
• Leesburg Regional Medical Center
• Leesburg Regional Medical Center D/B/a LRMC Nursing Center
• Leesburg Regional Medical Center Inc

• Rural Health Clinic/Center in Leesburg, FL
• Providers in Leesburg, 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 Jan 22, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.