St Augustine Adult & Pediatric Medicine PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME73431 Issued in FL

Legal business name

ST AUGUSTINE ADULT & PEDIATRIC MEDICINE PA

Practice address

67 S Dixie Hwy
St Augustine, FL 32084-0317

Phone

(904) 827-0032

Fax

(904) 827-0985

NPI assigned

Sep 15, 2005

Organization subpart

No

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

Authorized official

Name

Vandana Y Bhide, MD

Title

MD

Phone

(904) 827-0032

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289347200000",
    "number": "1174518179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 S DIXIE HWY",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320840317",
            "telephone_number": "904-827-0032",
            "fax_number": "904-827-0985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 S DIXIE HWY",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320840317",
            "telephone_number": "904-827-0032",
            "fax_number": "904-827-0985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST AUGUSTINE ADULT & PEDIATRIC MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2010-11-10",
        "status": "A",
        "authorized_official_last_name": "BHIDE",
        "authorized_official_first_name": "VANDANA",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "904-827-0032",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME73431",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME73431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252533000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "41496",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MC",
            "identifier": "110169538",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; 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.