NPIMap

Organization Active NPI

Pediatric Services of America, LLC

Doing business as Aveanna Healthcare

  • Home Health Agency
  • Panama City, FL
National Provider Identifier
1275069874
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PEDIATRIC SERVICES OF AMERICA, LLC
Doing business as
Aveanna Healthcare
Practice address
803 Jenks Ave Ste 24a
Panama City, FL 32401-2568
Phone
(850) 387-7685
NPI assigned
May 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Authorized official

Name
Matthew Buckhalter
Title
Cfo
Phone
(470) 464-8000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Nursing Care Agency 251J00000X

Addresses

Primary practice location

803 Jenks Ave Ste 24a
Panama City, FL 32401-2568

Mailing address

400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (470) 464-8000

Other names 1

  • Aveanna Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275069874. Details of each certification follow.

Home health agency certification: CCN 10K101

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
AVEANNA HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 11, 2023
Last certification
Jul 29, 2024
Facility address
803 Jenks Ave, Ste 24a
Panama City, FL 32401

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
10D2139853Pediatric Services of America LLC803 Jenks Avenue Ste 24-a, Panama City, FL 32401Certificate of waiverNov 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Services of76 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

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

View all 17

Locations

803 Jenks Ave
Ste 6
Panama City, FL 32401

NPI Registry JSON

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1275069874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 INTERSTATE NORTH PKWY SE STE 1600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395047",
            "telephone_number": "470-464-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 JENKS AVE STE 24A",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012568",
            "telephone_number": "850-387-7685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SERVICES OF AMERICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-03",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "BUCKHALTER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "470-464-8000"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aveanna Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Panama City, FL

Sources for this page

Verify at the official NPI Registry.