NPIMap

Organization Active NPI

Sanford Pediatric Associates PA

  • Pediatric Adolescent Medicine Physician
  • Orange City, FL
National Provider Identifier
1124491816
Registry record updated Nov 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
ME0045959 Issued in FL
Legal business name
SANFORD PEDIATRIC ASSOCIATES PA
Practice address
775 Harley Strickland Blvd
Suite 101
Orange City, FL 32763-7963
Phone
(386) 851-0644
Fax
(386) 851-0664
NPI assigned
Nov 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2015

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

Authorized official

Name
Dr. John Edward Terwilleger, M.D.NPI 1164468351
Title
President
Phone
(386) 851-0644

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
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X ME0045959 FL Primary

Addresses

Primary practice location

775 Harley Strickland Blvd
Suite 101
Orange City, FL 32763-7963

Mailing address

775 Harley Strickland Blvd
Suite 101
Orange City, FL 32763-7963
Phone (386) 851-0644

Other identifiers 1

IdentifierTypeStateIssuer
044243700MedicaidFL

National Provider Directory

National Provider Directory

Locations

775 Harley Strickland Blvd
Ste 101
Orange City, FL 32763
Phone (386) 851-0644

Practitioners & affiliated clinicians

Practitioners 1

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": "1446595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446595200000",
    "number": "1124491816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 HARLEY STRICKLAND BLVD",
            "address_2": "SUITE 101",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327637963",
            "telephone_number": "386-851-0644",
            "fax_number": "386-851-0664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 HARLEY STRICKLAND BLVD",
            "address_2": "SUITE 101",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327637963",
            "telephone_number": "386-851-0644",
            "fax_number": "386-851-0664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD PEDIATRIC ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-04",
        "last_updated": "2015-11-04",
        "status": "A",
        "authorized_official_last_name": "TERWILLEGER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-851-0644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "FL",
            "license": "ME0045959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044243700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; 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.