NPIMap

Organization Active NPI

Dr. Rosie'S Pediatrics

  • Pediatrics Physician
  • Port Saint Lucie, FL
National Provider Identifier
1336496629
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME91787 Issued in FL
Legal business name
DR. ROSIE'S PEDIATRICS
Practice address
466 SW Port Saint Lucie Blvd., Suite 116
Port Saint Lucie, FL 34953-2091
Phone
(772) 341-7433
Fax
(772) 237-4622
NPI assigned
Aug 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Authorized official

Name
Rosario Correa, APRNNPI 1215906557
Title
Owner
Phone
(772) 341-7433

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
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X ME91787 FL Primary

Addresses

Primary practice location

466 SW Port Saint Lucie Blvd., Suite 116
Port Saint Lucie, FL 34953-2091

Mailing address

466 SW Port Saint Lucie Blvd., Suite 116
Port Saint Lucie, FL 34953-2091
Phone (772) 341-7433

Other identifiers 2

IdentifierTypeStateIssuer
271863400MedicaidFL
U4547AOtherFLMEDICARE

Other names 1

  • Kid's Place Pediatrics, P.A. Doing business as

National Provider Directory

National Provider Directory

Locations

466 SW Port St Lucie Blvd
Ste 116
Port St Lucie, FL 34953
Phone (772) 237-4518

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1344211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1336496629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "466 SW PORT SAINT LUCIE BLVD., SUITE 116",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349532091",
            "telephone_number": "772-341-7433",
            "fax_number": "772-237-4622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "466 SW PORT SAINT LUCIE BLVD., SUITE 116",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349532091",
            "telephone_number": "772-341-7433",
            "fax_number": "772-237-4622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ROSIE'S PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-06",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "CORREA",
        "authorized_official_first_name": "ROSARIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-341-7433",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME91787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271863400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "U4547A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kid's Place Pediatrics, P.A.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Saint Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.