Sumter Pediatrics LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SUMTER PEDIATRICS LLC

Doing business as

Sumter Pediatrics

Practice address

340 US Highway 19 S
Leesburg, GA 31763-4872

Phone

(229) 814-1174

NPI assigned

Mar 12, 2015

Last updated

Apr 20, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nelson Madrazo, MDNPI 1295773687

Title

Managing Member

Phone

(229) 924-8082

Specialties & licenses 1

Addresses

Other names 1

• SUMTER PEDIATRICS Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Sumter Pediatrics LLC

  dba Sumter Pediatrics

  • Pediatrics Physician
  • Americus, GA
  • NPI 1144400664

  O20210201002591

  Same enrollment

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

Practitioners 4

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.

• Nelson Tan Madrazo, M.D.

  • Pediatrics Physician
  • Americus, GA
  • NPI 1295773687
  Authorized official Same address or phone
• Bridget April Barrow, NP

  • Nurse Practitioner
  • Montezuma, GA
  • NPI 1588949432
  NPD (past)
• Joshua Minich, APRN, RN

  • Family Nurse Practitioner
  • Montezuma, GA
  • NPI 1346514221
  NPD (past)
• Manuel R Tamondong Jr., M.D.

  • Pediatrics Physician
  • Montezuma, GA
  • NPI 1588729388
  NPD (past)

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

{
    "created_epoch": "1426118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461110400000",
    "number": "1033502299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 US HIGHWAY 19 S",
            "city": "LEESBURG",
            "state": "GA",
            "postal_code": "317634872",
            "telephone_number": "229-814-1174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 US HIGHWAY 19 S",
            "city": "LEESBURG",
            "state": "GA",
            "postal_code": "317634872",
            "telephone_number": "229-814-1174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMTER PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-12",
        "last_updated": "2016-04-20",
        "status": "A",
        "authorized_official_last_name": "MADRAZO",
        "authorized_official_first_name": "NELSON",
        "authorized_official_title_or_position": "MANAGING  MEMBER",
        "authorized_official_telephone_number": "229-924-8082",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUMTER PEDIATRICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Steven Joseph Stoklosa, OT R
• Marcia Wynn Stoler, RDH
• Tyler Ray Strom, DMD
• Sullivan Drug Company (The Pharmhouse)
• Shana Sullivan, PHARMD
• Crystal Lea Swain, COTA/L
• Sassy Lashawn Sylvester, FNP-C
• Angelica Lynn Tabb
• Andrea Taylor, RN, BSN
• Spencer Thomas Taylor

• Primary Care Clinic/Center in Leesburg, GA
• Providers in Leesburg, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.