NPIMap

Organization Active NPI

Pediatric Professional Associates, PC

  • Specialist
  • Methuen, MA
National Provider Identifier
1225158405
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PEDIATRIC PROFESSIONAL ASSOCIATES, PC
Practice address
413 Broadway
Methuen, MA 01844-2022
Phone
(978) 683-1974
Fax
(978) 689-9710
NPI assigned
Mar 30, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
David A. Avila, D.O.NPI 1295707834
Title
President
Phone
(978) 683-1974

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
Specialist 174400000X NU Primary

Addresses

Primary practice location

413 Broadway
Methuen, MA 01844-2022

Mailing address

413 Broadway
Methuen, MA 01844-2022

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D0703159Pediatric Professional Associates PC413 Broadway, Methuen, MA 01844Certificate of waiverDec 22, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225158405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 BROADWAY",
            "city": "METHUEN",
            "state": "MA",
            "postal_code": "018442022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 BROADWAY",
            "city": "METHUEN",
            "state": "MA",
            "postal_code": "018442022",
            "telephone_number": "978-683-1974",
            "fax_number": "978-689-9710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PROFESSIONAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AVILA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-683-1974",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Methuen, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.