NPIMap

Organization Active NPI

Pediatric Health Care Alliance, PA

  • Pediatrics Physician
  • Odessa, FL
National Provider Identifier
1124325154
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME65867 Issued in FL
Legal business name
PEDIATRIC HEALTH CARE ALLIANCE, PA
Practice address
1850 Crossings Blvd Unit 100
Odessa, FL 33556-6106
Phone
(813) 475-7100
Fax
(813) 475-7119
NPI assigned
Feb 28, 2011
Organization subpart
Yes
Parent organization
PEDIATRIC HEALTHCARE ALLIANCE, PA - SUNCOASTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Authorized official

Name
Debra S Gonzalez
Title
Coo
Phone
(813) 854-2003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X ME65867 FL Primary

Addresses

Primary practice location

1850 Crossings Blvd Unit 100
Odessa, FL 33556-6106

Mailing address

720 Brooker Creek Blvd Ste 215
Oldsmar, FL 34677-2937
Phone (813) 854-2003

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Health Care Alliance PA15 organizations share this tax ID, including this one
Part of
Pediatric Health Care Alliance PA

Other organizations with this tax ID 14

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

View all 14

Locations

720 Brooker Creek Blvd
Ste 215
Oldsmar, FL 34677
Phone (813) 854-2003

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1124325154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 BROOKER CREEK BLVD STE 215",
            "city": "OLDSMAR",
            "state": "FL",
            "postal_code": "346772937",
            "telephone_number": "813-854-2003",
            "fax_number": "813-436-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 CROSSINGS BLVD UNIT 100",
            "city": "ODESSA",
            "state": "FL",
            "postal_code": "335566106",
            "telephone_number": "813-475-7100",
            "fax_number": "813-475-7119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC HEALTH CARE ALLIANCE, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC HEALTHCARE ALLIANCE, PA - SUNCOAST",
        "enumeration_date": "2011-02-28",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "813-854-2003"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME65867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.