NPIMap

Organization Active NPI

Thomas a Fisk MD

  • Non-Pharmacy Dispensing Site
  • Maitland, FL
National Provider Identifier
1376589481
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
ME61050 Issued in FL
Legal business name
THOMAS A FISK MD
Practice address
New Interlochen Pediatrics
846 Lake Howell Rd
Maitland, FL 32751
Phone
(407) 767-2477
Fax
(407) 834-9822
NPI assigned
Jun 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Direndia Shackelford
Title
Managed Care Specialist
Phone
(800) 654-0889

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X ME61050 FL Primary

Addresses

Primary practice location

New Interlochen Pediatrics
846 Lake Howell Rd
Maitland, FL 32751

Mailing address

New Interlochen Pediatrics
846 Lake Howell Rd
Maitland, FL 32751

Other identifiers 2

IdentifierTypeStateIssuer
58690100MedicaidFL
1084312OtherOTHER ID NUMBER-COMMERCIAL NUMBER

National Provider Directory

National Provider Directory
Tax ID family
New Interlachen Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376589481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NEW INTERLOCHEN PEDIATRICS",
            "address_2": "846 LAKE HOWELL RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "32751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NEW INTERLOCHEN PEDIATRICS",
            "address_2": "846 LAKE HOWELL RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "32751",
            "telephone_number": "407-767-2477",
            "fax_number": "407-834-9822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS A FISK MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "DIRENDIA",
        "authorized_official_title_or_position": "MANAGED CARE SPECIALIST",
        "authorized_official_telephone_number": "800-654-0889"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ME61050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "58690100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1084312",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.