Heartland Pediatrics of Lake Wales, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

HEARTLAND PEDIATRICS OF LAKE WALES, LLC

Practice address

1354 State Road 60 E
Lake Wales, FL 33853-4322

Phone

(863) 679-8888

Fax

(863) 676-2851

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Laurence Thomas Hren

Title

Ceo

Phone

(863) 676-1770

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• HEARTLAND PEDIATRICS OF LAKE WALES, P.A. Former legal business name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Rural health clinic certification: CCN 103968

Legal name

HEARTLAND PEDIATRICS OF LAKE WALES, L.L.C.,

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jul 3, 1997

Last certification

Aug 3, 2023

Ownership / control type

1B

Most recent change of ownership

Jun 2, 2006 (1 total)

Organization structure

LLCProprietary

Incorporated

Jun 2, 2006 in FL

Enrollment address

1354 State Road 60 E
Lake Wales, FL 33853-4322

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

CLIA laboratory certificates

Tax ID family

Heartland Pediatrics of Lake Wales2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Heartland Pediatrics of Lake Wales, P.a.

  • Pediatrics Physician
  • Lake Wales, FL
  • NPI 1063433076
  NPD tax ID

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Avon Park Pediatrics, Inc.

  • Pediatrics Physician
  • Avon Park, FL
  • NPI 1811135502

  Central Florida Pediatric Associates Inc

  CMS ownership
• Heartland Pediatrics of Lake Placid, Inc.

  • Pediatrics Physician
  • Lake Placid, FL
  • NPI 1265453203

  Central Florida Pediatric Associates Inc

  CMS ownership
• Sonni'S Pediatrics, Inc.

  • Pediatrics Physician
  • Wauchula, FL
  • NPI 1760776900

  Central Florida Pediatric Associates Inc

  CMS ownership

Practitioners 1

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

• Rajeswari S Sonni, M.D.

  • Pediatrics Physician
  • Lake Wales, FL
  • NPI 1881640464
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1104989680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1354 STATE ROAD 60 E",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534322",
            "telephone_number": "863-679-8888",
            "fax_number": "863-676-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1354 STATE ROAD 60 E",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534322",
            "telephone_number": "863-679-8888",
            "fax_number": "863-676-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND PEDIATRICS OF LAKE WALES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "HREN",
        "authorized_official_first_name": "LAURENCE",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "863-676-1770"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251469900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "21247",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251469901",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEARTLAND PEDIATRICS OF LAKE WALES, P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Merrill Ann Hart, PA-C
• Andrei Hastings, MD
• Leonard E Hawkins, PA-C
• Heart & Vascular PLC
• Heart to Heart Group , LLC
• Heartland Pediatrics of Lake Wales, P.a.
• Heartnvascular
• Edward Helpling, CRNA
• Heraud Pediatrics LLC
• Liana Herisson, SLPA

• Pediatrics Physician in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.