NPIMap

Organization Active NPI

Anastasia Pediatrics

  • Pediatrics Physician
  • St Augustine, FL
National Provider Identifier
1205192739
Registry record updated Apr 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME0081118 Issued in FL
Legal business name
ANASTASIA PEDIATRICS
Practice address
100 Whetstone PL
Suite 205
St Augustine, FL 32086-5774
Phone
(904) 819-9925
Fax
(904) 819-9926
NPI assigned
Apr 10, 2012
Reactivated
Apr 30, 2013
Last updated
Apr 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2013

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

Authorized official

Name
Monali Manikal, MDNPI 1447276852
Title
Doctor
Phone
(904) 819-9925

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
Pediatrics Physician 208000000X ME0081118 FL Primary

Addresses

Primary practice location

100 Whetstone PL
Suite 205
St Augustine, FL 32086-5774

Mailing address

100 Whetstone PL
Suite 205
St Augustine, FL 32086-5774
Phone (904) 819-9925

Other identifiers 2

IdentifierTypeStateIssuer
003482600MedicaidFL
259789600MedicaidFL

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JDDGAA

Practitioners & affiliated clinicians

Practitioners 7

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": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367280000000",
    "number": "1205192739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WHETSTONE PL",
            "address_2": "SUITE 205",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865774",
            "telephone_number": "904-819-9925",
            "fax_number": "904-819-9926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WHETSTONE PL",
            "address_2": "SUITE 205",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865774",
            "telephone_number": "904-819-9925",
            "fax_number": "904-819-9926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANASTASIA PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "last_updated": "2013-04-30",
        "deactivation_date": "2012-08-31",
        "reactivation_date": "2013-04-30",
        "status": "A",
        "authorized_official_last_name": "MANIKAL",
        "authorized_official_first_name": "MONALI",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "904-819-9925",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME0081118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003482600",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "259789600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2013; 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.