NPIMap

Organization Active NPI

Pediatric Center for Excellence, LLC

  • Pediatric Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1215434980
Registry record updated Apr 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
Legal business name
PEDIATRIC CENTER FOR EXCELLENCE, LLC
Practice address
13241 Bartram Park Blvd Unit 209
Jacksonville, FL 32258-5233
Phone
(904) 224-5437
Fax
(904) 674-2313
NPI assigned
Apr 10, 2018
Last updated
Apr 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2018

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

Authorized official

Name
Ashraf A Affan, MDNPI 1477538593
Title
Owner
Phone
(904) 224-5437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251P0200X Primary
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

13241 Bartram Park Blvd Unit 209
Jacksonville, FL 32258-5233

Mailing address

13241 Bartram Park Blvd Unit 209
Jacksonville, FL 32258-5233
Phone (904) 224-5437

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1523318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523318400000",
    "number": "1215434980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD UNIT 209",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585233",
            "telephone_number": "904-224-5437",
            "fax_number": "904-674-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD UNIT 209",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585233",
            "telephone_number": "904-224-5437",
            "fax_number": "904-674-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CENTER FOR EXCELLENCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-10",
        "last_updated": "2018-04-10",
        "status": "A",
        "authorized_official_last_name": "AFFAN",
        "authorized_official_first_name": "ASHRAF",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-224-5437",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; 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.