Bernadette C. Antonyrajah, MD
Individual provider Active NPI Pediatrics Physician · Des Moines, IA
NPI 1295997666 · NPPES record last updated Jan 15, 2024
Key facts
- NPI
- 1295997666
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- ME113647 (FL)
- Practice address
- 1111 6TH Ave
Des Moines, IA 50314-2613 - Phone
- (515) 247-3330
- Fax
- (515) 643-8839
- NPI assigned
- Jun 27, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 12
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121112000642 | FL | Practitioner - Pediatric Medicine |
8022298108 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME113647 | FL | MD | Pediatric Emergency Medicine (Emergency Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Nemours Foundation | Current |
Accepting new patients | |
| Advanced Kid'S Care | Pediatrics | Current | Accepting new patients |
| Hospital Physician Services of Florida PA | Current |
Accepting new patients | |
| The Nemours Foundation | Current |
Accepting new patients | |
| The Nemours Foundation | Current | Accepting new patients | |
| Orlando Health, Inc. | Current | Accepting new patients | |
| Halifax Healthcare Systems Inc | Current |
Accepting new patients | |
| University Medical Service Association Inc | Current | Accepting new patients | |
| Tampa General Hospital | Current | Accepting new patients | |
| Advanced Kids Urgent Care Professionals LLC | Pediatrics | Current | Accepting new patients |
| Promedica Central Physicians | Past | Accepting new patients | |
| Promedica Children'S Specialists | Pediatrics | Past |
Accepting new patients |
Locations
303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285
807 Childrens Way
Jacksonville, FL 32207
Phone (904) 390-3600
6535 Nemours Pkwy
Orlando, FL 32827
Phone (407) 567-4000
98 Terra Mango Loop
Ste 12
Orlando, FL 32835
Phone (407) 354-0717
8383 N Davis Hwy
Pensacola, FL 32514
Phone (850) 494-3212
5153 N 9th Ave
Pensacola, FL 32504
Phone (850) 416-1575
2 Tampa General Cir
Tampa, FL 33606
Phone (813) 259-8700
Interoperability endpoints
- bantonyrajah27048@orlandohealth.medalliesdirect.net
- brampersad111602@direct.tgh.org
- https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Emergency Medicine (Emergency Medicine) Physician | 207PP0204X | ME113647 | FL | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | ME113647 | FL | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | MD-43932 | IA | |
| Pediatrics Physician | 208000000X | ME113647 | FL | Yes |
Addresses
Primary practice location
1111 6TH Ave
Des Moines, IA 50314-2613
Mailing address
PO Box 917770
Orlando, FL 32891-0001
Phone (813) 821-8038
Other practice location 1
2 Tampa General Cir
Tampa, FL 33606-3571
Phone (813) 821-8038
Other practice location 2
98 Terra Mango Loop Ste 12
Orlando, FL 32835-8515
Phone (407) 612-4007
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 006240200 | Medicaid | FL | |
| 14LE6 | Other | FL | BLUE CROSS BLUE SHIELD |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | bantonyrajah111602@direct.tgh.org |
Other providers in Des Moines, IA
- Opas Anothayanontha
- Anp Foot & Ankle Clinics, LLC
- Eduardo Sebastian Antezano
- Kimberly Antone
- Antonia L. Valadez, Lisw, LLC
- Nobles Antwi Jr.
- Roselin Faith Anukam
- Emily Marie Anzmann
- Teresa A Aoki
- Apex Health LLC
All providers in Des Moines, IA · Pediatrics Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.