Organization Active NPI

Advanced Pediatric Specialists LLC

  • Pediatrics Physician
  • Savannah, GA
National Provider Identifier
1073046397
Registry record updated Apr 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ADVANCED PEDIATRIC SPECIALISTS LLC
Practice address
5353 Reynolds St
Savannah, GA 31405-6015
Phone
(912) 819-6000
Fax
(386) 274-7801
NPI assigned
Apr 4, 2017
Last updated
Apr 4, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2017

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

Authorized official

Name
Mark Coffey, MDNPI 1144260274
Title
President
Phone
(912) 295-2133

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

5353 Reynolds St
Savannah, GA 31405-6015

Mailing address

PO Box 12189
Daytona Beach, FL 32120-2189
Phone (386) 274-7800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170703001659 GA Part B Supplier - Clinic/Group Practice 9830468073 Receives reassigned benefits from 4 practitioners
Practice locations: Savannah, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 278

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 278

NPI Registry JSON

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

{
    "created_epoch": "1491264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491264000000",
    "number": "1073046397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12189",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321202189",
            "telephone_number": "386-274-7800",
            "fax_number": "386-274-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5353 REYNOLDS ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056015",
            "telephone_number": "912-819-6000",
            "fax_number": "386-274-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PEDIATRIC SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-04",
        "last_updated": "2017-04-04",
        "status": "A",
        "authorized_official_last_name": "COFFEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-295-2133",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; 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.