Child Neurology Center of Northwest Florida PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

CHILD NEUROLOGY CENTER OF NORTHWEST FLORIDA PA

Practice address

400 Gulf Breeze Pkwy
Suite 300
Gulf Breeze, FL 32561-4495

Phone

(850) 932-5055

Fax

(850) 932-1401

NPI assigned

Nov 7, 2005

Organization subpart

No

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

Authorized official

Name

Mr. James Ben Renfroe, M.D.NPI 1780686717

Title

Owner

Phone

(850) 932-5055

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Child Neurology Center of Northwest Florida PA

  • General Practice Physician
  • Miramar Beach, FL
  • NPI 1760293872
  NPPES parent name

Practitioners 6

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

• James Ben Renfroe, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Gulf Breeze, FL
  • NPI 1780686717
  Medicare reassignment Care Compare group NPD Authorized official
• Mailande Dedeaux, PA

  • Medical Physician Assistant
  • Gulf Breeze, FL
  • NPI 1255708681
  Medicare reassignment Care Compare group
• Weldon Arnold Mauney III, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Gulf Breeze, FL
  • NPI 1396915898
  Medicare reassignment Care Compare group
• Fallon Crews, APRN

  • Pediatric Nurse Practitioner
  • Gulf Breeze, FL
  • NPI 1003099052
  NPD (past)
• Tracy A Ezelle, ARNP

  • Pediatric Nurse Practitioner
  • Gulf Breeze, FL
  • NPI 1861410979
  NPD (past)
• Arlene F Flores, ARNP

  • Family Nurse Practitioner
  • Gulf Breeze, FL
  • NPI 1407393267
  NPD (past)

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1053392233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325620280",
            "telephone_number": "850-932-5055",
            "fax_number": "850-932-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 GULF BREEZE PKWY",
            "address_2": "SUITE 300",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325614495",
            "telephone_number": "850-932-5055",
            "fax_number": "850-932-1401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12815 US Highway 98 W Ste 116",
            "address_purpose": "LOCATION",
            "city": "Miramar Beach",
            "state": "FL",
            "postal_code": "325503245",
            "country_code": "US",
            "telephone_number": "850-932-5055",
            "fax_number": "850-932-1404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHILD NEUROLOGY CENTER OF NORTHWEST FLORIDA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "RENFROE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "BEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-932-5055",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529918930",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257889100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chelsea Dore Cassler, M.A. BCBA
• Aletha Deandra Chamberlin, LMSW
• Madeline Chambers, APRN
• Shannon Chambers
• David Ray Chandler, MD
• Child Neurology Center of NW FL PA
• CHP Gulf Breeze FL Tenant Corp
• Karlee Clark, APRN
• Meredith Clark, ATC
• Ronald Harris Clayton

• General Practice Physician in Gulf Breeze, FL
• Providers in Gulf Breeze, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.