Active NPI
Syed Fahmeed Imam, MD
- Pediatrics Physician
- Palatka, FL
National Provider Identifier
1073090205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME162406
- Practice address
- 6910 Old Wolf Bay Rd
Palatka, FL 32177-6800 - Phone
- (386) 328-7337
- NPI assigned
- Jul 20, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 57 | ||
| Pediatrics Physician | 208000000X | ME162406 | FL | Primary |
Addresses
Primary practice location
6910 Old Wolf Bay Rd
Palatka, FL 32177-6800
Mailing address
Ruppert Health Center
3125 Transvers Dr
Toledo, OH 43614
Phone (419) 383-3771
Other practice location 1
Ruppert Health Center
3125 Transvers Dr
Toledo, OH 43614
Phone (419) 383-3771
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME162406 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saltzman, Tanis, Pittell, Levin and Jacobson | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Pediatric Associates
- Pediatrics Physician
- Hollywood, FL
- NPI 1639138480
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693267200000",
"number": "1073090205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RUPPERT HEALTH CENTER",
"address_2": "3125 TRANSVERS DR",
"city": "TOLEDO",
"state": "OH",
"postal_code": "43614",
"telephone_number": "419-383-3771",
"fax_number": "419-383-2937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6910 OLD WOLF BAY RD",
"city": "PALATKA",
"state": "FL",
"postal_code": "321776800",
"telephone_number": "386-328-7337"
}
],
"practiceLocations": [
{
"address_1": "Ruppert Health Center",
"address_2": "3125 Transvers Dr",
"address_purpose": "LOCATION",
"city": "Toledo",
"state": "OH",
"postal_code": "43614",
"country_code": "US",
"telephone_number": "419-383-3771",
"fax_number": "419-383-2937",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "IMAM",
"first_name": "SYED",
"middle_name": "FAHMEED",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-20",
"last_updated": "2023-08-29",
"certification_date": "2023-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": "57",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME162406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palatka, FL
- Hussein Zabad MD PA
- Hynes Internal Medicine LLC
- Bridgett Hynes, APRN
- Hyperbaric Health Services - Palatka LLC
- Iftikhar Ahmad M.D P.a.
- Individualized Medicine, LLC
- Infectious Diseases & Tropical Medicine PA
- Juanita R. Ingram
- Integrated Community Oncology Network LLC (Florida Radiation Oncology Group)
- Integrated Community Oncology Network LLC (ICON Oncology)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.