NPIMap

Organization Active NPI

Kidzcare Pediatrics, PC

  • Pediatrics Physician
  • Sanford, NC
National Provider Identifier
1255688958
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
KIDZCARE PEDIATRICS, PC
Practice address
145 W Main St
Sanford, NC 27332-5919
Phone
(919) 775-7337
Fax
(919) 775-1525
NPI assigned
Aug 13, 2012
Last updated
Aug 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Authorized official

Name
Shantae Renee Lockhart
Title
Credentials Manager
Phone
(910) 483-7337

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

145 W Main St
Sanford, NC 27332-5919

Mailing address

PO Box 9219
Fayetteville, NC 28311-9082
Phone (910) 483-7337

Other identifiers 2

IdentifierTypeStateIssuer
5921254MedicaidNC
016VROtherNCBCBS OF NC

Other names 1

  • Pediatric Associates, PC Former legal business 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
34D2046695Kidzcare Pediatrics, PC145 W. Main Street, Sanford, NC 27332Certificate of waiverSep 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
Kidzcare Pediatrics PC28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Locations

145 W Main St
Sanford, NC 27332
Phone (919) 775-7337

Practitioners & affiliated clinicians

Practitioners 3

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": "1344816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1255688958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9219",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283119082",
            "telephone_number": "910-483-7337",
            "fax_number": "910-483-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 W MAIN ST",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273325919",
            "telephone_number": "919-775-7337",
            "fax_number": "919-775-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDZCARE PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-13",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "LOCKHART",
        "authorized_official_first_name": "SHANTAE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CREDENTIALS MANAGER",
        "authorized_official_telephone_number": "910-483-7337"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5921254",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "016VR",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Associates, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Pediatric Associates, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Sanford, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.