NPIMap

Organization Active NPI

Sumter Pediatrics PA

  • Rural Health Clinic/Center
  • Sumterville, FL
National Provider Identifier
1174924757
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
ME72542 Issued in FL
Legal business name
SUMTER PEDIATRICS PA
Practice address
617 S US 301 Ste B
Sumterville, FL 33585-5355
Phone
(352) 569-4980
Fax
(352) 569-4981
NPI assigned
Sep 15, 2014
Last updated
Jan 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Authorized official

Name
Dr. Mohammad Afzal, MDNPI 1669411161
Title
Doctor
Phone
(352) 394-3929

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X ME72542 FL Primary
Pediatrics Physician 208000000X ME72542 FL

Addresses

Primary practice location

617 S US 301 Ste B
Sumterville, FL 33585-5355

Mailing address

617 S US 301 Ste B
Sumterville, FL 33585-5355
Phone (352) 569-4980

Other identifiers 1

IdentifierTypeStateIssuer
014683500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141203000217 FL Part A Provider - Rural Health Clinic 2769704709 Practice locations: Sumterville, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174924757. Details of each certification follow.

Rural health clinic certification: CCN 683816

Legal name
SUMTER PEDIATRICS PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 4, 2015
Last certification
Jun 9, 2026
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Aug 26, 2014 in FL
Enrollment address
617 S US Hwy 301 Suite B
Sumterville, FL 33585-5355

National Provider Directory

National Provider Directory
Tax ID family
Sumter Pediatrics PA2 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.

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Sumter Pediatrics PA Organization, Sumterville, FL Corporation 5% Or Greater Direct Ownership Interest Sep 1, 2014
5% Or Greater Security Interest Sep 1, 2014
Operational/Managerial Control Aug 26, 2014 100%
Mohammad Afzal Individual 5% Or Greater Direct Ownership Interest Sep 1, 2014 100%
Corporate OfficerBilling Manager Sep 1, 2014
W-2 Managing EmployeeCeo Sep 1, 2014

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1410739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1174924757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 S US 301 STE B",
            "city": "SUMTERVILLE",
            "state": "FL",
            "postal_code": "335855355",
            "telephone_number": "352-569-4980",
            "fax_number": "352-569-4981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 S US 301 STE B",
            "city": "SUMTERVILLE",
            "state": "FL",
            "postal_code": "335855355",
            "telephone_number": "352-569-4980",
            "fax_number": "352-569-4981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMTER PEDIATRICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-15",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "AFZAL",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "352-394-3929",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "ME72542",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME72542",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014683500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumterville, FL

Sources for this page

Verify at the official NPI Registry.