NPIMap

Organization Active NPI

Pediatric Associates at Argyle PA

  • Pediatrics Physician
  • Jacksonville, FL
National Provider Identifier
1063557460
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES AT ARGYLE PA
Practice address
8351 Westport Rd
Jacksonville, FL 32244-5901
Phone
(904) 317-8811
Fax
(904) 317-4949
NPI assigned
Feb 21, 2007
Last updated
Jun 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

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

Authorized official

Name
Ruby Rendon
Title
Administrator
Phone
(904) 317-8811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

8351 Westport Rd
Jacksonville, FL 32244-5901

Mailing address

8351 Westport Rd
Jacksonville, FL 32244-5901
Phone (904) 317-8811

Other identifiers 2

IdentifierTypeStateIssuer
277899800MedicaidFL
255283300MedicaidFL

National Provider Directory

National Provider Directory

Locations

9957 Moorings Dr
Ste 201
Jacksonville, FL 32257

107 Edwards Rd
#B
Starke, FL 32091
Phone (904) 368-0368

Ownership & related parties

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.

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623283200000",
    "number": "1063557460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8351 WESTPORT RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322445901",
            "telephone_number": "904-317-8811",
            "fax_number": "904-317-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8351 WESTPORT RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322445901",
            "telephone_number": "904-317-8811",
            "fax_number": "904-317-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES AT ARGYLE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A",
        "authorized_official_last_name": "RENDON",
        "authorized_official_first_name": "RUBY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-317-8811"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "277899800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255283300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.