NPIMap

Organization Active NPI

Andres R Villar MD

Doing business as Children's Medical Center

  • Rural Health Clinic/Center
  • Live Oak, FL
National Provider Identifier
1295829398
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ANDRES R VILLAR MD
Doing business as
Children's Medical Center
Practice address
1002 11TH St SW
Live Oak, FL 32064-3606
Phone
(386) 364-8050
Fax
(386) 364-7068
NPI assigned
Oct 3, 2006
Last updated
Jul 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Authorized official

Name
Andres R Villar, MDNPI 1164421855
Title
Administrator
Phone
(386) 755-5044

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1002 11TH St SW
Live Oak, FL 32064-3606

Mailing address

PO Box 606
Glen St Mary, FL 32040-0606
Phone (904) 653-1818

Other names 1

  • Children's Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041014001074 FL Part A Provider - Rural Health Clinic 5092623439 Practice locations: Live Oak, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295829398. Details of each certification follow.

Rural health clinic certification: CCN 103868

Legal name
ANDRES R VILLAR MD
Doing business as
CHILDREN'S MEDICAL CENTER LIVE OAK
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 7, 1994
Last certification
Aug 2, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
Apr 16, 1992 in FL
Enrollment address
1002 11TH SWST
Live Oak, FL 32064-3606

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Andres R Villar MD6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

122 Suwannee Ave NW
Branford, FL 32008
Phone (386) 935-2998

1002 11th St SW
Live Oak, FL 32064
Phone (386) 364-8050

311 NW 250th St
Newberry, FL 32669
Phone (352) 472-6776

319 W Call St
Ste B
Starke, FL 32091
Phone (904) 368-9102

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Andres Villar Individual 5% Or Greater Direct Ownership Interest Apr 16, 1992 100%
Corporate OfficerPresident Apr 16, 1992 100%
W-2 Managing EmployeePresident Oct 24, 2018
Operational/Managerial ControlPresident Apr 16, 1992 100%
Rebecca Villar Individual W-2 Managing EmployeeAdministrator Oct 24, 2018

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": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1295829398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 606",
            "city": "GLEN ST MARY",
            "state": "FL",
            "postal_code": "320400606",
            "telephone_number": "904-653-1818",
            "fax_number": "904-653-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 11TH ST SW",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320643606",
            "telephone_number": "386-364-8050",
            "fax_number": "386-364-7068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDRES R VILLAR MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "VILLAR",
        "authorized_official_first_name": "ANDRES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "386-755-5044",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Children's Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Live Oak, FL

Sources for this page

Verify at the official NPI Registry.