NPIMap

Organization Active NPI

North Florida Pediatrics, PA.

  • Rural Health Clinic/Center
  • Lake City, FL
National Provider Identifier
1376548602
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
ME87551 Issued in FL
Legal business name
NORTH FLORIDA PEDIATRICS, PA.
Practice address
North Florida Pediatrics PA .
1859 SW Newland Way
Lake City, FL 32025
Phone
(386) 758-0003
Fax
(386) 755-4432
NPI assigned
Jun 14, 2005
Last updated
Sep 8, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH FLORIDA PEDIATRICS, P.AAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

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

Authorized official

Name
Samuel Santelices, MD.NPI 1669476552
Title
President/ Ceo
Phone
(386) 758-0003

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X ME87551 FL
Pediatric Adolescent Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2080A0000X ME87551 FL
Rural Health Clinic/Center 261QR1300X ME87551 FL Primary

Addresses

Primary practice location

North Florida Pediatrics PA .
1859 SW Newland Way
Lake City, FL 32025

Mailing address

1859 SW Newland Way
Lake City, FL 32025-6966
Phone (386) 758-0003

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100301000379 FL Part A Provider - Rural Health Clinic 8729997929 Practice locations: Lake City, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376548602. Details of each certification follow.

Rural health clinic certification: CCN 103931

Legal name
NORTH FLORIDA PEDIATRICS, PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 9, 1996
Last certification
Nov 30, 2023
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Nov 29, 1995 in FL
Enrollment address
1859 SW Newland Way
Lake City, FL 32025-6966

Other NPIs with the same Medicare PAC ID 5

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

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
10D0911918North Florida Pediatrics1859 SW Newland Way, Lake City, FL 32025Certificate of waiverOct 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
North Florida Pediatrics PA18 organizations share this tax ID, including this one
Part of
North Florida Pediatrics PA

Other organizations with this tax ID 17

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

View all 17

Locations

2220 N Young Blvd
Chiefland, FL 32626
Phone (352) 221-7337

1859 SW Newland Way
Fl Pediatrics
Lake City, FL 32025
Phone (386) 758-0003

1101 Ohio Ave S
Live Oak, FL 32064
Phone (386) 339-1060

1301 Reid St
Palatka, FL 32177
Phone (386) 325-1025

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Samuel Santelices Individual 5% Or Greater Direct Ownership Interest Jan 1, 2010 100%
Corporate OfficerOwner Jan 1, 2010 100%
W-2 Managing Employee Jan 1, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Acute Care Pediatrics,PAPalatka, FL, CCN 108985 Rural health clinic 5% Or Greater Direct Ownership Interest May 1, 2024
Acute Care Pediatrics of Palm Coast PAPalm Coast, FL, CCN 108997 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1376548602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1859 SW NEWLAND WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256966",
            "telephone_number": "386-758-0003",
            "fax_number": "386-755-4432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NORTH FLORIDA PEDIATRICS PA .",
            "address_2": "1859 SW NEWLAND WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "32025",
            "telephone_number": "386-758-0003",
            "fax_number": "386-755-4432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH FLORIDA PEDIATRICS, PA.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH FLORIDA PEDIATRICS, P.A",
        "enumeration_date": "2005-06-14",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A",
        "authorized_official_last_name": "SANTELICES",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "386-758-0003",
        "authorized_official_credential": "MD."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME87551",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "FL",
            "license": "ME87551",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "ME87551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, FL

Sources for this page

Verify at the official NPI Registry.