NPIMap

Organization Active NPI

Polk Pediatrics

  • Pediatrics Physician
  • Bartow, FL
National Provider Identifier
1376689711
Registry record updated Mar 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME0029864 Issued in FL
Legal business name
POLK PEDIATRICS
Practice address
1265 E Main St
Bartow, FL 33830-5006
Phone
(863) 534-3737
Fax
(863) 533-6323
NPI assigned
Jan 30, 2007
Last updated
Mar 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2014

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

Authorized official

Name
Dr. Ananthakrishna Pillai, MD
Title
Doctor
Phone
(863) 534-3737

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME0029864 FL Primary

Addresses

Primary practice location

1265 E Main St
Bartow, FL 33830-5006

Mailing address

1265 E Main St
Bartow, FL 33830-5006
Phone (863) 534-3737

Other identifiers 2

IdentifierTypeStateIssuer
067708600MedicaidFL
59264OtherFLBCBS ID #

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
10D0965336Polk Pediatrics1265 E Main Street, Bartow, FL 33830Certificate of waiverSep 19, 2027

National Provider Directory

National Provider Directory

Locations

1265 E Main St
Bartow, FL 33830
Phone (863) 534-3737

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DHDDCA

Practitioners & affiliated clinicians

Practitioners 6

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": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395964800000",
    "number": "1376689711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 E MAIN ST",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338305006",
            "telephone_number": "863-534-3737",
            "fax_number": "863-533-6323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 E MAIN ST",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338305006",
            "telephone_number": "863-534-3737",
            "fax_number": "863-533-6323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2014-03-28",
        "status": "A",
        "authorized_official_last_name": "PILLAI",
        "authorized_official_first_name": "ANANTHAKRISHNA",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "863-534-3737",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME0029864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067708600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID #",
            "identifier": "59264",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartow, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.