NPIMap

Organization Active NPI

Pensacola Pediatrics, PA

  • Pediatrics Physician
  • Pensacola, FL
National Provider Identifier
1255004586
Registry record updated Aug 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PENSACOLA PEDIATRICS, PA
Practice address
9301 Beatrice Dr
Pensacola, FL 32514-5867
Phone
(850) 476-7555
Fax
(850) 466-3777
NPI assigned
Aug 2, 2021
Last updated
Aug 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2021

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

Authorized official

Name
Peter Heckathorn
Title
Administrator
Phone
(850) 473-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

9301 Beatrice Dr
Pensacola, FL 32514-5867

Mailing address

4951 Grande Dr
Pensacola, FL 32504-8965
Phone (850) 473-0100

Other identifiers 1

IdentifierTypeStateIssuer
063018702MedicaidFL

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
10D2014347Pensacola Pediatrics9301 Beatrice Dr, Pensacola, FL 32514ComplianceDec 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Pensacola Pediatrics PA9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 29

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.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627862400000",
    "number": "1255004586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4951 GRANDE DR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048965",
            "telephone_number": "850-473-0100",
            "fax_number": "850-473-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9301 BEATRICE DR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325145867",
            "telephone_number": "850-476-7555",
            "fax_number": "850-466-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENSACOLA PEDIATRICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-02",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A",
        "authorized_official_last_name": "HECKATHORN",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "850-473-0100"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063018702",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.