Heartland Pediatrics of Lake Placid, Inc.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

HEARTLAND PEDIATRICS OF LAKE PLACID, INC.

Practice address

344 E Royal Palm St
Suite # 3
Lake Placid, FL 33852-5020

Phone

(863) 699-1414

Fax

(863) 699-9790

NPI assigned

Jul 23, 2006

Organization subpart

No

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

Authorized official

Name

Laurence Thomas Hren

Title

Ceo

Phone

(863) 676-1770

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Rural health clinic certification: CCN 108907

Legal name

HEARTLAND PEDIATRICS OF LAKE PLACID, INC.

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 11, 1998

Last certification

Aug 1, 2023

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Jan 26, 1998 in FL

Enrollment address

344 E Royal Palm Street
Suite 3
Lake Placid, FL 33852-5020

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Avon Park Pediatrics, Inc.

  • Pediatrics Physician
  • Avon Park, FL
  • NPI 1811135502

  Central Florida Pediatric Associates Inc

  CMS ownership
• Heartland Pediatrics of Lake Wales, LLC

  • Pediatrics Physician
  • Lake Wales, FL
  • NPI 1104989680

  Central Florida Pediatric Associates Inc

  CMS ownership
• Sonni'S Pediatrics, Inc.

  • Pediatrics Physician
  • Wauchula, FL
  • NPI 1760776900

  Central Florida Pediatric Associates Inc

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anavatti L Raghuveera, M.D.

  • Pediatrics Physician
  • Lake Placid, FL
  • NPI 1811943376
  NPD (past)

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1265453203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 E ROYAL PALM ST",
            "address_2": "SUITE # 3",
            "city": "LAKE PLACID",
            "state": "FL",
            "postal_code": "338525020",
            "telephone_number": "863-699-1414",
            "fax_number": "863-699-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 E ROYAL PALM ST",
            "address_2": "SUITE # 3",
            "city": "LAKE PLACID",
            "state": "FL",
            "postal_code": "338525020",
            "telephone_number": "863-699-1414",
            "fax_number": "863-699-9790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND PEDIATRICS OF LAKE PLACID, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "HREN",
        "authorized_official_first_name": "LAURENCE",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "863-676-1770"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF FLORIDA",
            "identifier": "21799",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253535101",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253535100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronisha Hawthorne, OTA
• HC Medical and Cosmetic Products LLC
• Healthnomics LLC
• Heartland Medical Supply Inc
• Heartland Medical Supply Inc
• Heartland Pharmacy Lake Placid
• Heartland Pharmacy Lake Placid Inc
• Heartland Pharmacy Lake Placid Inc
• Michael James Henry, DO
• Gallardo De Grano Hermoso, PT

• Pediatrics Physician in Lake Placid, FL
• Providers in Lake Placid, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.