Little Pine Pediatrics PLLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

LITTLE PINE PEDIATRICS PLLC

Practice address

15551 NW US Highway 441 Unit 40
Alachua, FL 32615-9330

Phone

(386) 518-0102

Fax

(386) 518-0116

NPI assigned

Jun 22, 2016

Organization subpart

No

Name

Dr. Ronald Emerick Jr., D.O.

Title

Owner

Phone

(855) 577-5437

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

• Ronald Emerick Jr., D.O.

  • Pediatrics Physician
  • Perry, FL
  • NPI 1205894425

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

  CMS ownership

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Little Pine Pediatrics PLLC

  • Rural Health Clinic/Center
  • Madison, FL
  • NPI 1497007553

  0244380152

  Same PAC ID
• Little Pine Pediatrics, PLLC

  • Rural Health Clinic/Center
  • Perry, FL
  • NPI 1376784702

  0244380152

  Same PAC ID

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

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in FL

Rural health clinic certification: CCN 683825

Legal name

LITTLE PINE PEDIATRICS, PLLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Apr 24, 2018

Last certification

Apr 19, 2021

Ownership / control type

1B

Organization structure

LLCProprietary

Incorporated

Mar 4, 2009 in FL

Enrollment address

15551 NW Hwy 441
Suite 40
Alachua, FL 32615-0001

Enrollment records 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Tax ID family

Little Pine Pediatrics PLLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

• Little Pine Pediatrics PLLC

  • General Practice Physician
  • Alachua, FL
  • NPI 1053084913
  NPD tax ID
• Little Pine Pediatrics PLLC

  • Rural Health Clinic/Center
  • Madison, FL
  • NPI 1497007553
  NPD tax ID
• Little Pine Pediatrics, PLLC

  • Primary Care Clinic/Center
  • Madison, FL
  • NPI 1043761539
  NPD tax ID
• Little Pine Pediatrics, PLLC

  • Rural Health Clinic/Center
  • Monticello, FL
  • NPI 1316612492
  NPD tax ID
• Little Pine Pediatrics, PLLC

  • Primary Care Clinic/Center
  • Perry, FL
  • NPI 1811447824
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 3, 2021.

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1043661994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 S JEFFERSON ST",
            "city": "PERRY",
            "state": "FL",
            "postal_code": "323485611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15551 NW US HIGHWAY 441 UNIT 40",
            "city": "ALACHUA",
            "state": "FL",
            "postal_code": "326159330",
            "telephone_number": "386-518-0102",
            "fax_number": "386-518-0116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE PINE PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-22",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "EMERICK",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "855-577-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS9746",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH TAXONOMY",
            "identifier": "261QR1300X",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "208000000X",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larry J Latour OD PA
• Larry J Latour, O.D. P.A.
• Emilie Lenes, PHD
• Joshua P Levy, L.M.T.
• Lori Listzwan
• Little Pine Pediatrics PLLC
• Panthea Macknight, LMT
• Sierra Mackritis
• Dana Mahmoud
• James W McCauley, MD

• All providers in Alachua, FL
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; 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.