NPIMap

Organization Active NPI

Sacred Heart Medical Group

  • Pediatrics Physician
  • Freeport, FL
National Provider Identifier
1235800160
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SACRED HEART MEDICAL GROUP
Practice address
281 State Highway 20 E
Freeport, FL 32439-3929
Phone
(850) 278-3400
NPI assigned
Sep 21, 2021
Last updated
Sep 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Authorized official

Name
Jean Vallier
Title
Director
Phone
(850) 278-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

281 State Highway 20 E
Freeport, FL 32439-3929

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623

Other names 1

  • SHMG Pediatrics at Freeport Other name

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
10D1053271Sacred Heart Medical Group at Freeport281 State Hwy 20 E, Freeport, FL 32439Certificate of waiverApr 18, 2028

National Provider Directory

National Provider Directory
Tax ID family
Sacred Heart Specialty99 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

281 State Highway 20 E
Freeport, FL 32439
Phone (850) 278-3400

NPI Registry JSON

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

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1235800160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 STATE HIGHWAY 20 E",
            "city": "FREEPORT",
            "state": "FL",
            "postal_code": "324393929",
            "telephone_number": "850-278-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED HEART MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-21",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "VALLIER",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "850-278-3400"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHMG Pediatrics at Freeport",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Freeport, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; 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.