Jacksonville Kids Pediatrics LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

JACKSONVILLE KIDS PEDIATRICS LLC

Practice address

7807 Baymeadows Rd E
Suite 207
Jacksonville, FL 32256-9664

Phone

(904) 253-3459

NPI assigned

May 22, 2008

Last updated

May 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexandra Mary Kostur, M.D.NPI 1770562464

Title

Owner

Phone

(904) 253-3459

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Alexandra M Kostur, M.D.

  • Pediatrics Physician
  • Jacksonville, FL
  • NPI 1770562464
  NPD (past) Authorized official
• Sara Michelle Dahbour, APRN

  • Pediatric Nurse Practitioner
  • Jacksonville, FL
  • NPI 1912307414
  NPD (past)
• Amanda Kling, APRN

  • Pediatric Nurse Practitioner
  • Jacksonville, FL
  • NPI 1356171953
  NPD (past)
• Lori M Olivarez, APRN

  • Pediatric Nurse Practitioner
  • Jacksonville, FL
  • NPI 1336191121
  NPD (past)

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211414400000",
    "number": "1083871404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13743 SAXON LAKE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322252624",
            "telephone_number": "904-253-3459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7807 BAYMEADOWS RD E",
            "address_2": "SUITE 207",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569664",
            "telephone_number": "904-253-3459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE KIDS PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2008-05-22",
        "status": "A",
        "authorized_official_last_name": "KOSTUR",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-253-3459",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.